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Lee H, Kim H, Lee S, Lee GJ. Establishing Reference Values for a New Computerized Cognitive Function Test Program for Children. Ann Rehabil Med 2024; 48:135-145. [PMID: 38644639 PMCID: PMC11058362 DOI: 10.5535/arm.230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To establish reference values for the computerized cognitive test and evaluate cognitive function improvements across different age groups, we introduce the computerized Cognitive Function Test program (eCFT), specifically designed for children. We aimed to establish eCFT reference values and assess cognitive function improvements across different age groups. METHODS We included children aged 3-6 years with confirmed normal cognition based on the Korean Developmental Screening Test for Infants and Children and Kaufman Assessment Battery for Children-II. The eCFT consists of 8 subtests for visual perception, attention, memory, and executive function. RESULTS A total of 66 participants (36 males and 30 females) with an average age of 4.4 years participated. The age 6 group consistently outperformed both age group 3 and 4 in terms of correct responses. With regard to the completed stage, the "selective auditory stimulus" test findings were 2.0 and 3.9 for the age 3 and age 6 groups, respectively (p<0.05). The "trail-making" test findings were 1.7, 2.1, 2.6, and 2.8, respectively (between ages 3 and 6, p<0.01; between ages 4 and 6, p<0.05); moreover, the age 5 group surpassed the age 3 group (2.6 and 1.7, respectively, p<0.05). CONCLUSION The eCFT is an easily accessible tool to evaluate cognitive function in young children. We introduce reference values with a cutoff range for preschool-aged children, enabling early intervention for those with cognitive impairment. Given its accessibility and relatively short evaluation time, the eCFT has potential for clinical use.
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Affiliation(s)
- Hyunji Lee
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Hajeong Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Suan Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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Vlčkova B, Halámka J, Müller M, Sanz-Mengibar JM, Šafářová M. Can Clinical Assessment of Postural Control Explain Locomotive Body Function, Mobility, Self-Care and Participation in Children with Cerebral Palsy? Healthcare (Basel) 2024; 12:98. [PMID: 38201004 PMCID: PMC10779062 DOI: 10.3390/healthcare12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Trunk control may influence self-care, mobility, and participation, as well as how children living with cerebral palsy (CP) move around. Mobility and Gross Motor performance are described over environmental factors, while locomotion can be understood as the intrinsic ontogenetic automatic postural function of the central nervous system, and could be the underlying element explaining the relationship between these factors. Our goal is to study the correlation among Trunk Control Measurement Scale (TCMS) and Pediatric Evaluation of Disability Inventory (PEDI) domains, as well as Locomotor Stages (LS). METHODS A feasibility observational analysis was designed including 25 children with CP who were assessed with these scales. RESULTS The strong correlation confirms higher levels of trunk control in children with better self-care, mobility and participation capacities. Strong correlations indicate also that higher LS show better levels of PEDI and TCMS domains. CONCLUSIONS Our results suggest that more mature LS require higher levels of trunk control, benefitting self-care, mobility and social functions.
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Affiliation(s)
- Blanka Vlčkova
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
| | - Jiří Halámka
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
| | - Markus Müller
- Physiotherapy Department, Evangelisches Krankenhaus Düsseldorf Sozialpädiatrisches Zentrum, 40217 Düsseldorf, Germany;
| | - Jose Manuel Sanz-Mengibar
- Queen Square Centre for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Marcela Šafářová
- Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (B.V.); (J.H.); (M.Š.)
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3
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Burgess A, Reedman S, Chatfield MD, Ware RS, Sakzewski L, Boyd RN. Development of gross motor capacity and mobility performance in children with cerebral palsy: a longitudinal study. Dev Med Child Neurol 2022; 64:578-585. [PMID: 34800033 DOI: 10.1111/dmcn.15112] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe development of gross motor capacity and mobility performance in children with cerebral palsy. METHOD This longitudinal cohort study measured gross motor capacity with the Gross Motor Function Measure and mobility performance with the Pediatric Evaluation of Disability Inventory (PEDI) between 18 months and 5 years, and the PEDI - Computer Adaptive Test (PEDI-CAT) between 8 years and 12 years. Longitudinal analyses used mixed-effects regression modelling with interaction between age and Gross Motor Function Classification System (GMFCS). Stability of GMFCS levels over time was measured using agreement. RESULTS Two hundred and twenty-two children provided 871 observations (median 4 observations, range 1-7). Children classified in GMFCS level I improved in both capacity and performance until 8 to 12 years. Children classified in GMFCS levels II and III continued to develop mobility performance after gross motor capacity had plateaued at 5 years. Children classified in GMFCS level IV plateaued at 5 years in capacity and performance. Children classified in GMFCS level V showed no changes in capacity or performance between 18 months and 8 to 12 years. Stability of GMFCS levels was 73%. INTERPRETATION Change in mobility performance over time somewhat reflected gross motor capacity trajectories. Continued improvement in mobility performance after plateau of gross motor capacity for children classified in GMFCS levels II and III suggests importance of other personal or environmental factors.
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Affiliation(s)
- Andrea Burgess
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Reedman
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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4
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de Leeuw MJ, Schasfoort FC, Spek B, van der Ham I, Verschure S, Westendorp T, Pangalila RF. Factors for changes in self-care and mobility capabilities in young children with cerebral palsy involved in regular outpatient rehabilitation care. Heliyon 2021; 7:e08537. [PMID: 34950787 PMCID: PMC8671866 DOI: 10.1016/j.heliyon.2021.e08537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/14/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Assessing prognosis of self-care and mobility capabilities in children with cerebral palsy (CP) is important for goal setting, treatment guidance and meaningful professional-caregiver conversations. Aims Identifying factors associated with changes in self-care and mobility capabilities in regular outpatient multidisciplinary paediatric CP rehabilitation care. Methods and procedures Routinely monitored longitudinal data, assessed with the Paediatric Evaluation of Disability Inventory (PEDI-Functional-Skills-Scale, FSS 0–100) was retrospectively analysed. We determined contributions of age, gross-motor function, bimanual-arm function, intellectual function, education type, epilepsy, visual function, and psychiatric comorbidity to self-care and mobility capability changes (linear-mixed-models). Outcomes and results For 90 children (53 boys), in all Gross-Motor-Function-Classification-System (GMFCS) levels, 272 PEDI's were completed. Mean PEDI–FSS–scores at first measurement (median age: 3,2 years) for self-care and mobility were 46.3 and 42.4, and mean final FSS-scores respectively were 55.1 and 53.1 (median age: 6,5 years). Self-care capability change was significantly associated with age (2.81, p < 0.001), GMFCS levels III-V (-9.12 to -46.66, p < 0.01), and intellectual impairment (-6.39, p < 0.01). Mobility capability change was significantly associated with age (3.25, p < 0.001) and GMFCS levels II-V (-6.58 to -47.12, p < 0.01). Conclusions and implications Most important prognostic factor for self-care and mobility capabilities is GMFCS level, plus intellectual impairment for self-care. Maximum capability levels are reached at different ages, which is important for individual goal setting and managing expectations. Capabilities of children with CP improve modestly over time in outpatient rehabilitation. Children with more severe CP reach maximum mobility and self-care levels at an earlier age. After this maintaining capabilities is more realistic than improvement. Important prognostic factors are GMFCS level and intellectual impairment. Routine monitoring can aid goal setting and expectation management in communication with families.
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Affiliation(s)
- Marleen J de Leeuw
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands.,Department of General Practice, Intellectual Disability Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Fabienne C Schasfoort
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Bea Spek
- Department of Clinical Epidemiology, Biostatistics & Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Inez van der Ham
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands
| | - Stella Verschure
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands
| | - Tessa Westendorp
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands
| | - Robert F Pangalila
- Rijndam Rehabilitation, P.O. Box 23181, 3001 KD, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
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5
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Jha KK, Karunanithi GB, Sahana A, Karthikbabu S. Randomised trial of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functions among children with bilateral spastic cerebral palsy. Somatosens Mot Res 2021; 38:117-126. [PMID: 33655813 DOI: 10.1080/08990220.2021.1876016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Balance issues and poor gross motor function affect the daily needs of children with cerebral palsy. PURPOSE The study objective was to examine the effects of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functioning among children with bilateral spastic cerebral palsy. METHOD Thirty-eight children with bilateral spastic cerebral palsy aged 6-12 years with GMFCS- level II-III, Manual Ability Classification System level I-III participated in this randomized controlled trial. The experimental group performed virtual reality games and physiotherapy, while the control group underwent physiotherapy alone. The exercise intensity was 60 minutes session a day, 4-days a week for 6-weeks. Paediatric Balance Scale (PBS), Kids-Mini-Balance Evaluation System Test (Kids-Mini-BESTest), Gross Motor Function Measure-88 (GMFM-88), and Wee-Functional Independence Measure (WeeFIM) were the outcome measures collected at baseline, 6-week post-training and 2-months follow-up. RESULTS The time by group interaction of repeated measures ANOVA revealed no statistical significance for all the outcome measures except Kids-Mini-BESTest (p < 0.05). The PBS and, Kids-Mini-BESTest improved by a mean (standard deviation) score of 5.1(1.7) and 8.7(2.8) points, respectively in the experimental group as compared to control group [3.4(1.6) and 5.8(2.5) points]. These gains remained at follow-up (p < 0.001). CONCLUSION Combined virtual reality gaming and physiotherapy is not superior over physiotherapy alone in improving the gross motor performance and daily functioning among children with bilateral spastic cerebral palsy. Virtual gaming, along with physiotherapy, appears to be beneficial in their balance capacity, warranting further trials to investigate the same in children with GMFCS level-III.
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Affiliation(s)
| | | | - A Sahana
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | - Suruliraj Karthikbabu
- Manipal Academy of Higher Education, Manipal College of Health Professions, Department of Physiotherapy, MHB, Bangalore, India
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6
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Vaillant E, Geytenbeek JJM, Jansma EP, Oostrom KJ, Vermeulen RJ, Buizer AI. Factors associated with spoken language comprehension in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2020; 62:1363-1373. [PMID: 32852786 PMCID: PMC7692918 DOI: 10.1111/dmcn.14651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/01/2022]
Abstract
AIM To identify factors that are relevant for spoken language comprehension in children with cerebral palsy (CP), following the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) framework. METHOD A systematic literature search was conducted using the electronic literature databases PubMed, Embase, PsycInfo, and Cochrane Library, from January 1967 to December 2019. Included studies involved children with CP, results regarding spoken language comprehension, and analysis of at least one associated factor. Factors were classified within ICF-CY domains. RESULTS Twenty-one studies met inclusion criteria. Factors in the ICF-CY domains of body functions and structure were most frequently reported. White brain matter abnormalities, motor type, functional mobility, and intellectual functioning appear to be relevant factors in spoken language comprehension in CP. Factors in the domain of activities and participation, as well as contextual factors, have rarely been studied in the context of spoken language comprehension in CP. INTERPRETATION Most factors known to be important for spoken language comprehension in typically developing children and/or known to be susceptible to change by interventions are understudied in CP.
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Affiliation(s)
- Emma Vaillant
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Johanna J M Geytenbeek
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elise P Jansma
- Department of Epidemiology and BiostatisticsEMGO+ Institute for Health and Care Research and Medical LibraryAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Kim J Oostrom
- Psychosocial DepartmentAmsterdam Reproduction and DevelopmentEmma Children’s HospitalAmsterdam UMCUniversity of Amsterdam and Vrije Universiteit AmsterdamAmsterdamthe Netherlands
| | | | - Annemieke I Buizer
- Department of Rehabilitation MedicineAmsterdam Movement SciencesAmsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
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7
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The Participation of Children with Intellectual Disabilities: Including the Voices of Children and Their Caregivers in India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186706. [PMID: 32942575 PMCID: PMC7557845 DOI: 10.3390/ijerph17186706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022]
Abstract
There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child’s or the caregiver’s perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children’s participation. This paper reports on both perceptions—those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children’s Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child–caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children’s participation.
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8
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Dada S, Bastable K, Halder S. The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6644. [PMID: 32933056 PMCID: PMC7558089 DOI: 10.3390/ijerph17186644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022]
Abstract
Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers' capacity to support children's participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children's Assessment of Participation and Enjoyment (CAPE). One hundred caregiver-child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children's participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child's participation. These factors need to be considered when generalising results from different countries.
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Affiliation(s)
- Shakila Dada
- Centre for Augmentative and Alternative Communication, Humanities Faculty, University of Pretoria, Pretoria 0002, South Africa;
| | - Kirsty Bastable
- Centre for Augmentative and Alternative Communication, Humanities Faculty, University of Pretoria, Pretoria 0002, South Africa;
| | - Santoshi Halder
- Department of Education, University of Calcutta, Alipore Campus, 1 Reformatory St., Kolkata 700027, India;
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9
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Pontes TB, Mah K, Arnold AK, Polatajko HJ, Davis JA. The occupational repertoires of children with mobility difficulties: The child’s perspective. Br J Occup Ther 2020. [DOI: 10.1177/0308022619897877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Children with mobility difficulties are thought to share similar participation repertoires due to the impact of their physical impairments. However, with these children, as with all others, individual differences and contexts should mediate occupational repertoires and experiences, resulting in participation differences, at least in part. This study aimed to explore the occupational repertoires of children with mobility difficulties and their view of their occupational participation. Methods Five children with mobility difficulties were assessed using the paediatric activity card sort, to establish their occupational repertoires. Semi-structured interviews were used to understand the children’s occupational participation. Findings Our findings suggest that children with mobility issues are more likely to participate in quiet occupations, but not exclusively. The children defined participation in their own way. Conclusion The knowledge about how children with mobility difficulties understand participation in occupation can help occupational therapists to establish goals with their clients and personalise interventions.
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Affiliation(s)
| | - Katie Mah
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Adrianne K Arnold
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Helene J Polatajko
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Jane A Davis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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10
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van Gorp M, Dallmeijer AJ, van Wely L, de Groot V, Terwee CB, Flens G, Stam HJ, van der Slot W, Roebroeck ME. Pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy. Disabil Rehabil 2019; 43:2164-2171. [PMID: 34275407 DOI: 10.1080/09638288.2019.1694998] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Investigate pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy compared to references. MATERIALS AND METHODS Young adults with cerebral palsy (n = 97, aged 21-34 years) and age-matched references from the general population (n = 190) rated pain using a numeric rating scale and fatigue, depressive symptoms, sleep disturbance and global health using Patient-Reported Outcomes Measurement Information System® short forms. Scores were compared between cerebral palsy subgroups and the reference population. Correlation coefficients and linear regression analyses assessed interrelationships of health issues and associations with global health. RESULTS Individuals with Gross Motor Function Classification System level I had less pain, fatigue and depressive symptoms, while individuals with levels II and III-V had more pain (53% and 56%, p < 0.001) and those with levels III-V more fatigue (39%, p = 0.035) than references (pain: 26%, fatigue: 14%). Pain and fatigue were more interrelated (correlation coefficients: 0.71 vs. 0.41) and stronger associated with global mental health in individuals with cerebral palsy. CONCLUSIONS Young adults with Gross Motor Function Classification System levels II-V report more pain and those with levels III-V report more fatigue than references. Pain and fatigue are highly interrelated and specifically relate to mental health in individuals with cerebral palsy.Implications for rehabilitationExcept for those in the highest level of motor function, young adults with cerebral palsy report higher levels of pain and fatigue compared to the general population of the same age.Pain and fatigue are strongly interrelated and associated with mental health in young adults with cerebral palsy.The present study recommends to monitor pain and fatigue in young adults with cerebral palsy with low levels of gross motor function.We advise rehabilitation professionals to consider combined treatment for both pain and fatigue.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gerard Flens
- Akwa GGZ (Alliance for Quality in Mental Health Care), Utrecht, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilma van der Slot
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
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11
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van Gorp M, E Roebroeck M, van Eck M, M Voorman J, Twisk JWR, J Dallmeijer A, van Wely L. Childhood factors predict participation of young adults with cerebral palsy in domestic life and interpersonal relationships: a prospective cohort study. Disabil Rehabil 2019; 42:3162-3171. [PMID: 31060408 DOI: 10.1080/09638288.2019.1585971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine childhood predictors of participation in domestic life and interpersonal relationships of young adults with cerebral palsy (CP).Materials and methods: This 13-year follow-up of an existing cohort (baseline age 9-13 years) included 67 young adults with CP (age 21-27 years). The Vineland adaptive behavior scales (VABS) and Life Habits questionnaire were used to assess attendance and difficulty in participation in domestic life and interpersonal relationships. Baseline factors were categorised according to the international classification of functioning, disability, and health. Stepwise multiple linear regression analyses determined significant predictors (p < 0.05).Results: Lower manual ability, intellectual disability (ID), epilepsy and lower motor capacity predicted decreased future participation in domestic life, and/or interpersonal relationships (explained variance R2 = 67-87%), whereas no association was found with environmental and personal factors. Extending models with baseline fine motor skills, communication, and interpersonal relationships increased R2 to 79-90%.Conclusions: Childhood factors account for 79-90% of the variation in young adult participation in domestic life and interpersonal relationships of individuals with CP. Children with limited motor capacity, low manual ability, ID, or epilepsy are at risk for restrictions in participation in young adulthood. Addressing fine motor, communication, and social skills in paediatric rehabilitation might promote young adult participation.Implications for rehabilitationChildhood risk factors for limited participation in domestic life and interpersonal relationships as a young adult with CP are ID, epilepsy, low manual ability, low motor capacity, and low activity & participation levels.In line with current practice, this study confirms the importance of addressing gross and fine motor skills in children with CP for their future participation in domestic life.In addition, results suggest that addressing communication and social skills during paediatric rehabilitation may optimise future participation in interpersonal relationships.
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Affiliation(s)
- Marloes van Gorp
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jeanine M Voorman
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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12
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Burgess A, Boyd RN, Ziviani J, Ware RS, Sakzewski L. Self-care and manual ability in preschool children with cerebral palsy: a longitudinal study. Dev Med Child Neurol 2019; 61:570-578. [PMID: 30294776 DOI: 10.1111/dmcn.14049] [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: 08/07/2018] [Indexed: 02/03/2023]
Abstract
AIM To describe longitudinal development of self-care and its relationship to manual ability in children with cerebral palsy (CP) aged 18 months to 5 years across all functional abilities. METHOD This was a prospective longitudinal population-based study of 290 children with CP (178 [61%] males, 112 [39%] females). Self-care was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). At 60 months (n=242), children were classified using the Manual Ability Classification System (MACS); 113 in level I (47%), 61 in MACS level II (25%), 24 in MACS level III (10%), 14 in MACS level IV (6%), and 30 in MACS level V (12%). Measures were taken at 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months of age. Longitudinal analyses were performed using mixed-effects linear regression models. RESULTS Self-care development achieved by 60 months was negatively associated with the severity of manual ability impairment. Distinct self-care developmental trajectories were found with estimated changes in PEDI self-care scaled scores per month: 0.61 for MACS level I, 0.46 for MACS levels II, 0.31 for MACS level III, 0.16 for MACS level IV, and 0.03 for MACS level V. Children classified in MACS level V had the lowest level of self-care skills at 18 months and showed no progress in self-care development. INTERPRETATION This study reports rate of self-care development in preschool children with CP. Self-care performance was highest in children with greatest manual ability. Clinicians may use rates of change to predict or monitor self-care performance. PEDI trajectories inform goal setting in discussions with families regarding expected levels of independence in self-care. WHAT THIS PAPER ADDS Distinct self-care developmental trajectories in children with cerebral palsy were found according to Manual Ability Classification System (MACS) levels. Children in MACS levels IV and V with epilepsy did not show any significant change in self-care. Children in MACS levels IV and V without epilepsy demonstrated small yet significant gains in self-care performance.
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Affiliation(s)
- Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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13
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Kavlak E, Tekin F. Examining various factors affecting communication skills in children with cerebral palsy. NeuroRehabilitation 2019; 44:161-173. [PMID: 30856125 DOI: 10.3233/nre-182580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Cerebral palsied children may have difficulties in acting as senders and/or receivers in the communication process. The aim of this study is examining that which maternal and child-related factors affect the communication skills of cerebral palsied children. METHODS 188 cerebral palsy diagnosed children ages between 2-18 years were assessed by Communication Function Classification System for communication skills. Maternal factors such as occupation, and educational status, and child-related factors such as gender, time of birth, clinical type of cerebral palsy, origin period of cerebral palsy; also daily living activities and gross motor functions of children were included in the assessment for examining how they affect the communication skills of cerebral palsied children. RESULTS Lower maternal age, higher gross motor function level, ataxic type and hemiparetic involvement (p < 0,05); educational status, maternal unemployment, female gender, and premature birth (p > 0,05) affected positively on the communication skills. There were no effects of delivery method (p > 0,05). CONCLUSIONS Communication skills of cerebral palsied children are affected by maternal age, educational status, occupation, and child's gender, birth term, origin period of cerebral palsy, clinical type of cerebral palsy, extremity involvement, motor development level and gross motor function. But the method of delivery has no effect on the communication functions of cerebral palsied children.
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Affiliation(s)
- Erdoğan Kavlak
- Pamukkale University School of Physical Therapy and Rehabilitation, Denizli, Turkey
| | - Fatih Tekin
- Pamukkale University School of Physical Therapy and Rehabilitation, Denizli, Turkey
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14
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Böhm H, Wanner P, Rethwilm R, Döderlein L. Prevalence and predictors for the ability to run in children and adolescents with cerebral palsy. Clin Biomech (Bristol, Avon) 2018; 58:103-108. [PMID: 30071441 DOI: 10.1016/j.clinbiomech.2018.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/23/2018] [Accepted: 07/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Running is a fundamental movement skill and a prerequisite for children to participate in numerous daily activities. The prevalence of the ability to run in people with Cerebral Palsy and the role of their impairments on running ability are unknown. Therefore, the aim of this study is to determine the prevalence of the ability to run and to identify contributing factors. METHODS In this study, 280 children and adolescents with spastic Cerebral Palsy, Gross Motor Function Classification System level II were included. The ability to run was defined by instrumented running analysis. Runners and non-runners were compared regarding their clinical measures of spasticity, weakness, and postural control. Logistic regression was applied to identify the most important predictors for the ability to run. FINDINGS The ability to run was significantly higher in unilateral (67%) than in bilateral (55%) affected patients. Significant differences between runners and non-runners were found for spasticity, BMI and postural control, but not for muscle strength. Lower M. rectus femoris spasticity, higher m gastrocnemius spasticity and enhanced postural control appear to be the best predictors for being able to run. INTERPRETATION Patients with Gross Motor Function Classification System level II represent a large group in the gait laboratory and the functional impairment within this group differs greatly. Therefore, for clinical decision making we suggest to separate patients in this group based on their running ability. Spasticity and postural control affect the ability to run and needs to be accounted for in intervention programs.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany.
| | - Philipp Wanner
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany; Department of Sport Science, Friedrich Alexander University Erlangen-Nürnberg, Gebbertstr. 123 b, 91058 Erlangen, Germany
| | - Roman Rethwilm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany
| | - Leonhard Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, 83229 Aschau i. Chiemgau, Germany
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15
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Taheri A, Perry A, Minnes P. Exploring factors that impact activity participation of children and adolescents with severe developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1151-1161. [PMID: 29154492 DOI: 10.1111/jir.12437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite the benefits of social participation, children and adolescents with developmental disabilities (DD) are often excluded from taking part in social activities. There is a gap in the literature about the factors that contribute to adequate participation of children with severe DD in particular and the barriers to their participation. Taking an ecological perspective, the purpose of this study was to examine child, family and community variables that may impact the activity participation of children and adolescents with severe DD. METHODS A total of 197 parents of children with severe DD (4-19 years) completed a survey, addressing a wide range of child, family and community related variables, as well as a measure of activity participation. RESULTS Overall, the final model significantly accounted for 30% of the variance in activity participation. Higher adaptive behaviour, greater parental socialisation and placement in an integrated school programme were significant predictors of greater activity participation. CONCLUSION Child, family and community factors were all important in understanding the activity participation of children with severe DD, thus supporting the value of an ecological approach. Suggestions for future research and clinical implications are discussed.
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Affiliation(s)
- A Taheri
- Department of Psychology, York University, Ontario, Canada
| | - A Perry
- Department of Psychology, York University, Ontario, Canada
| | - P Minnes
- Psychology, Queen's University, Ontario, Canada
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16
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Kim K, Kang JY, Jang DH. Relationship Between Mobility and Self-Care Activity in Children With Cerebral Palsy. Ann Rehabil Med 2017; 41:266-272. [PMID: 28503460 PMCID: PMC5426278 DOI: 10.5535/arm.2017.41.2.266] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/31/2016] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the factors influencing the development of self-care activity, and the association between mobility and self-care activity in children with cerebral palsy (CP). Methods A total of 63 CP children aged ≥4 years, were studied retrospectively. Children with severe intellectual disability or behavioral problems were excluded. The relationship between the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Pediatric Evaluation of Disability Inventory (PEDI) was analyzed. Simple and multiple linear regression analyses were conducted for continuous variables, such as verbal intelligence quotient (IQ) and PEDI subscales. Results Final evaluation was done for 25 children, ranging from 4 to 11 years of age. According to GMFCS levels, the differences in PEDI-self-care scores, showed statistically borderline significance (p=0.051). Conversely, differences in PEDI-self-care scores according to CP types and MACS levels were not statistically significant. Simple linear regression analysis showed that PEDI mobility and PEDI social function significantly influence the PEDI self-care. Multiple linear regression analysis showed that PEDI mobility was the only factor significantly influencing PEDI self-care in children aged ≥7 years (R2=0.875, p=0.03). Conclusion Mobility is important for the acquisition of self-care abilities in children with CP aged ≥7 years.
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Affiliation(s)
- Kyeongwon Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Hamer EG, Hielkema T, Bos AF, Dirks T, Hooijsma SJ, Reinders-Messelink HA, Toonen RF, Hadders-Algra M. Effect of early intervention on functional outcome at school age: Follow-up and process evaluation of a randomised controlled trial in infants at risk. Early Hum Dev 2017; 106-107:67-74. [PMID: 28282530 DOI: 10.1016/j.earlhumdev.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The long-term effect of early intervention in infants at risk for developmental disorders is unclear. The VIP project (n=46, originally) evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physiotherapy (TIP). AIMS To evaluate the effect of early intervention on functional outcome at school age. METHODS AND PROCEDURES Parents of 40 children (median age 8.3years) participated in this follow-up study. Outcome was assessed with a standardised parental interview (Vineland Adaptive Behaviour Scale) and questionnaires (Developmental Coordination Disorder Questionnaire, Child Behaviour Checklist, Utrechtse Coping List, and questions on educational approach). Quantified video information on physiotherapeutic actions during infancy was available. OUTCOMES AND RESULTS Child functional outcome in the two randomised groups was similar. Process evaluation revealed that some physiotherapeutic actions were associated with child mobility and parental educational approach at follow-up: e.g., training and instructing were associated with worse mobility. CONCLUSIONS AND IMPLICATIONS Functional outcome at school age after early intervention with COPCA is similar to that after TIP. However, some specific physiotherapeutic actions, in particular the physiotherapist's approach, are associated with outcome. WHAT THIS PAPER ADDS Early intervention is generally applied in infants at risk for developing disorders, with the aim of improving overall functional outcome. However, little is known on the long-term effect. The VIP project evaluated by means of a randomised controlled trial the effect of the family centred early intervention programme COPCA (Coping with and Caring for infants with special needs) in comparison to that of traditional infant physical therapy (TIP). Outcome at 18months corrected age was virtually similar. Process evaluation of the physiotherapy actions revealed that some characteristics of COPCA were associated with improved developmental outcome at 18months. This paper presents data on functional outcome at school age (median 8.3years) in 87% of the original participants. Outcome of infants who received three months of COPCA and that of infants who received three months of TIP was similar. Yet, parents of families who had received the COPCA intervention still more often used a trial and error approach when the child learned a new skill than parents of children who had received TIP. Process evaluation showed that more time spent on caregiver training and strict instructions during early intervention was associated with worse mobility. Four other physiotherapeutic actions were associated with parental educational approach. None of the neuromotor actions were associated with child outcome at school age. We conclude that long-term outcome after three months of COPCA or TIP is similar. However, our study does suggest that the professional approach of the physiotherapist can make a difference.
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Affiliation(s)
- Elisa G Hamer
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Tjitske Hielkema
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Neonatology, Groningen, The Netherlands
| | - Tineke Dirks
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Siebrigje J Hooijsma
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands; Rehabilitation Centre 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
| | - Rivka F Toonen
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Centre for Rehabilitation, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
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Mei C, Reilly S, Reddihough D, Mensah F, Pennington L, Morgan A. Language outcomes of children with cerebral palsy aged 5 years and 6 years: a population-based study. Dev Med Child Neurol 2016; 58:605-11. [PMID: 26566585 DOI: 10.1111/dmcn.12957] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
AIM To examine the frequency, range, and features of language impairment in a community sample of children with cerebral palsy (CP) aged 5 to 6 years. METHOD Children with CP born between 2005 and 2007 were identified through the Victorian Cerebral Palsy Register. Eighty-four participants were recruited, representing 48% of the contacted families. The recruited sample was representative of non-participants. Participants completed standardized measures of receptive and expressive language, and non-verbal cognition. RESULTS Language impairment was identified in 61% (51/84) of participants. Twenty-four per cent (20/84) were non-verbal. Co-occurring receptive and expressive language impairment was common (37/84, 44%). Isolated receptive (6/84, 7%) and expressive (4/84, 5%) impairments occurred relatively infrequently. At a group level, verbal and non-verbal participants demonstrated deficits across language subdomains (i.e. semantics, syntax, morphology), rather than in single domains. Cognitive impairment and Gross Motor Function Classification System levels IV and V were associated with higher rates of language impairment (odds ratio [OR] 15.2, 95% confidence interval [CI] 3.2-71.8 and OR 8.5, 95% CI 1.8-40.3 respectively). Only cognition was independently associated with language impairment when both of these factors were considered within a multivariable model. INTERPRETATION Language impairment was common in 5-year-old and 6-year-old children with CP, affecting three out of five children. Participants were impaired across linguistic subdomains indicating a generalized language deficit. Findings suggest most children would benefit from a clinical language assessment. To target services effectively, subgroups of individuals with CP at greatest risk for language impairment need to be identified.
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Affiliation(s)
- Cristina Mei
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Menzies Health Institute, Gold Coast, Qld, Australia
| | - Dinah Reddihough
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
| | - Fiona Mensah
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
| | - Lindsay Pennington
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Morgan
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
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Vos RC, Becher JG, Voorman JM, Gorter JW, van Eck M, van Meeteren J, Smits DW, Twisk JW, Dallmeijer AJ. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy. Arch Phys Med Rehabil 2016; 97:1329-37. [PMID: 27085848 DOI: 10.1016/j.apmr.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/22/2016] [Accepted: 03/20/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). DESIGN A prospective cohort study. SETTING Rehabilitation departments of university medical centers and rehabilitations centers. PARTICIPANTS A sample (N=327) consisting of 148 children (aged 5-9y) and 179 youth (aged 11-20y) with CP, Gross Motor Function Classification System level I (n=180), level II (n=44), level III (n=36), level IV (n=34), and level V (n=33). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gross motor capacity was assessed with the Gross Motor Function Measure-66 over a period of 2 to 4 years in different age cohorts. Neuromusculoskeletal function included selective motor control (SMC), muscle strength, spasticity, and range of motion (ROM) of the lower extremities. RESULTS Multilevel analyses showed that SMC was significantly associated with gross motor capacity in children and youth with CP, showing higher values and a more favorable course of gross motor capacity in those with better SMC. Strength was only associated with gross motor capacity in youth. Reduced ROM of hip (children) and knee extension (youth) and spasticity of the hip adductors (youth) were additionally-but more weakly-associated with lower values and a less favorable course of gross motor capacity. CONCLUSIONS Results indicate that children and youth with more severely impaired SMC and youth with reduced muscle strength have a less favorable course of gross motor capacity, while spasticity and reduced ROM are less determinative.
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Affiliation(s)
- Rimke C Vos
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jan Willem Gorter
- CanChild Center for Childhood Disability Research, McMaster University, Hamilton, Canada; Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands
| | - Mirjam van Eck
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jetty van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Wouter Smits
- Partner of NetChild, Network for Childhood Disability Research, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Jos W Twisk
- Department of Biostatistics and Methodology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Annet J Dallmeijer
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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20
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Hamer EG, Bos AF, Hadders-Algra M. Specific characteristics of abnormal general movements are associated with functional outcome at school age. Early Hum Dev 2016; 95:9-13. [PMID: 26896696 DOI: 10.1016/j.earlhumdev.2016.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders. AIM To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age. STUDY DESIGN Observational cohort study (long-term follow-up). SUBJECTS Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011). OUTCOME MEASURES A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures. RESULTS Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores. CONCLUSIONS The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome.
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Affiliation(s)
- Elisa G Hamer
- Department of Pediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands; Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend F Bos
- Department of Pediatrics, Division of Neonatology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- Department of Pediatrics, Division of Developmental Neurology, University of Groningen, University Medical Center, Groningen, The Netherlands.
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Chiarello LA, Bartlett DJ, Palisano RJ, McCoy SW, Fiss AL, Jeffries L, Wilk P. Determinants of participation in family and recreational activities of young children with cerebral palsy. Disabil Rehabil 2016; 38:2455-68. [DOI: 10.3109/09638288.2016.1138548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lisa A. Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Robert J. Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Lynn Jeffries
- Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Centre, Oklahoma, OK, USA
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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22
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Abstract
PURPOSE The purpose of this case report was to describe changes in body functions and structures, activities, and participation after a biweekly 10-week program of home physical therapy and hippotherapy using a weighted compressor belt. PARTICIPANT A 13-year-old boy with spastic diplegic cerebral palsy, Gross Motor Function Classification System level II, was referred because of accelerated growth and functional impairments that limited daily activities. OUTCOME MEASURES The Modified Ashworth Scale, passive range of motion, 1-Minute Walk Test, Timed Up and Down Stairs, Pediatric Balance Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Dimensions of Mastery Questionnaire 17 were examined at baseline, 5, and 10 weeks. OUTCOMES Data at 5 and 10 weeks demonstrated positive changes in passive range of motion, balance, strength, functional activities, and motivation, with additional improvements in endurance and speed after 10 weeks. CLINICAL IMPLICATIONS This report reveals enhanced body functions and structures and activities and improved participation and motivation.
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23
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James S, Ziviani J, Ware RS, Boyd RN. Relationships between activities of daily living, upper limb function, and visual perception in children and adolescents with unilateral cerebral palsy. Dev Med Child Neurol 2015; 57:852-7. [PMID: 25703777 DOI: 10.1111/dmcn.12715] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 12/01/2022]
Abstract
AIM This study examined relationships between activities of daily living (ADL) motor and process skills, unimanual capacity, bimanual performance, and visual perception in children with unilateral cerebral palsy (CP). METHOD Participants were 101 children with unilateral CP (51 males, 50 females; mean age 11y 9mo [SD 2y 5mo; range 8-17y]; Manual Ability Classification System [MACS] level I=24; level II=76; level III=1). Measures were (1) Assessment of Motor and Process Skills (AMPS), (2) Jebsen-Taylor Test of Hand Function (JTTHF), (3) Assisting Hand Assessment (AHA), and (4) Test of Visual Perceptual Skills, 3rd edition (TVPS-3). Regression models were constructed with the AMPS motor scale and AMPS process as the dependent variables. RESULTS The AHA and JTTHF dominant upper limb score together explained 57% of the variance in AMPS motor scale scores. TVPS-3 Visual Sequential Memory, TVPS-3 Visual Closure, and JTTHF dominant upper limb score together explained 35% of the variance in AMPS process scale scores. INTERPRETATION Bimanual performance and unimanual capacity of the dominant upper limb are significantly associated with ADL motor skills in children with unilateral CP. Process skills of ADL are related to visual perceptual ability and dominant upper limb unimanual capacity, which may reflect motor planning required to perform daily tasks.
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Affiliation(s)
- Sarah James
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Royal Children's Hospital, The University of Queensland, Brisbane, Qld, Australia
| | - Jenny Ziviani
- Children's Allied Health Research, Queensland Health, Brisbane, Qld, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Qld, Australia.,Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Royal Children's Hospital, The University of Queensland, Brisbane, Qld, Australia
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Wu KP, Chuang YF, Chen CL, Liu IS, Liu HT, Chen HC. Predictors of participation change in various areas for preschool children with cerebral palsy: a longitudinal study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 37:102-111. [PMID: 25460224 DOI: 10.1016/j.ridd.2014.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/09/2014] [Accepted: 11/09/2014] [Indexed: 06/04/2023]
Abstract
This study identifies potential predictors of participation changes in various areas for preschool children with cerebral palsy (CP). Eighty children with CP (2-6 years) were enrolled. Seven potential predictors were identified: age; sex; socioeconomic status, CP subtype; cognitive function, Function Independence Measure for Children (WeeFIM), and motor composite variable from 5 motor factors (gross motor function classification system (GMFCS) level; bimanual fine motor function level; selective motor control score; Modified Ashworth Scale score; and Spinal Alignment and Range of Motion Measure). Outcome was assessed at baseline and at 6-month follow-up using the Assessment of Preschool Children's Participation (APCP) including diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation, social activities (SA), and total areas. Dependent variables were change scores of APCP scores at baseline and 6-month follow-up. Regression analyses shows age and sex together predicted for APCP-total, APCP-SD diversity and APCP-total intensity changes (r(2)=0.13-0.25, p<0.001); cognitive function and WeeFIM were negative predictors for APCP-SA and APCP-PA diversity changes, respectively. CP subtype, motor composite variable, and socioeconomic status predicted for APCP changes in some areas. Findings suggest that young boys with poor cognitive function and daily activity predicted most on participation changes.
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Affiliation(s)
- Katie P Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fu-Hsing St., Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Yu-fen Chuang
- Department of Physical Therapy, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, 5 Fu-Hsing St., Kwei-Shan, Tao-Yuan 333, Taiwan; Graduate Institute of Early Intervention, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - I-shu Liu
- Graduate Institute of Early Intervention, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Hsiang-tseng Liu
- Graduate Institute of Early Intervention, Chang Gung University, 259 Wen-Hwa 1st Rd, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Hsieh-ching Chen
- Department of Industrial Engineering and Management, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 106, Taiwan.
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Johnson BA, Sheng X, Perry AS, Stevenson DA. Activity and participation in children with neurofibromatosis type 1. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:213-221. [PMID: 25462482 DOI: 10.1016/j.ridd.2014.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Abstract
We describe activity and participation in children and youth with neurofibromatosis type 1 (NF1), and compared an intervention and control group after a strengthening program using the Pediatric Outcomes Data Collection Instrument (PODCI) and the Children's Assessment of Participation and Enjoyment (CAPE). Questionnaires were filled out by parents at baseline, 12-weeks, and 1-year. The intervention group performed a strengthening program twice a week for ten weeks, followed by a 9-month independent program. Thirty-six participants (18 control, 18 intervention) between the ages of 5- and 18-years (mean 10.6 years, SD 4.6 years) were enrolled, and 34 completed the 1-year assessment. There were significant differences between formal and informal participation (p<0.0001) in baseline CAPE scores for the entire cohort. At 12 weeks, PODCI upper extremity function improved in intervention and decreased in controls (p=0.040), while happiness declined in intervention and increased in control (p=0.003). There were no significant differences between control and intervention groups in any of the CAPE or PODCI change scores from baseline to 1-year. Upper extremity function, sport and physical function, comfort/pain and happiness PODCI scores were lower than normative values. The NF1 cohort had low participation in formal active physical and skill-based activities. The companionship and location dimensions suggest participation occurs with family and other relatives in the home or a relative's home and reflects a pattern of social isolation from peers.
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Affiliation(s)
- Barbara A Johnson
- Shriners Hospitals for Children Salt Lake City, Salt Lake City, UT, United States.
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Amber S Perry
- Shriners Hospitals for Children Salt Lake City, Salt Lake City, UT, United States
| | - David A Stevenson
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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Kanagasabai PS, Mulligan H, Mirfin-Veitch B, Hale LA. Association between motor functioning and leisure participation of children with physical disability: an integrative review. Dev Med Child Neurol 2014; 56:1147-1162. [PMID: 25164864 DOI: 10.1111/dmcn.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 11/27/2022]
Abstract
AIM The aim of this integrative review is to synthesize the evidence of association between motor functioning and leisure participation of children with physical disability. METHOD We conducted a systematic electronic search of key databases from the period 1 January 2001 to 30 April 2014 using relevant keywords. The Mixed Method Appraisal Tool was used to assess the quality of the qualitative and quantitative studies included and carried out in children with physical disability aged 6 to 12 years. We synthesized and compared information from both type of studies to identify the extent, and way by which, motor functioning influences leisure participation. RESULTS Thirty-five studies were included and analyzed for this review. Twenty-four studies used quantitative and 11 studies used qualitative methodology. We identified the association between motor functioning and six dimensions of participation including diversity, intensity, context, preferences, enjoyment and quality of participation. Motor functioning was found to have a weak to moderate association with involvement in specific leisure activity types and dimensions. We developed a conceptual framework to illustrate the influence of motor functioning on leisure participation from this review. INTERPRETATION Whether motor functioning poses a barrier to leisure participation for children with physical disability appears to depend on the functional movement required to participate in a particular leisure activity.
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Affiliation(s)
- Parimala S Kanagasabai
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hilda Mulligan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Leigh A Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Konst MJ, Matson JL, Goldin RL, Williams LW. Socialization and nonverbal communication in atypically developing infants and toddlers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3416-3422. [PMID: 25200676 DOI: 10.1016/j.ridd.2014.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/19/2014] [Indexed: 06/03/2023]
Abstract
Emphasis on early identification of atypical development has increased as evidence supporting the efficacy of intervention has grown. These increases have also directly affected the availability of funding and providers of early intervention services. A majority of research has focused on interventions specific to an individual's primary diagnoses. For example, interventions for those with cerebral palsy (CP) have traditionally focused on physiological symptoms, while intervention for individuals with Autism Spectrum Disorder (ASD) focus on socialization, communication, and restricted interests and repetitive behaviors. However deficits in areas other than those related to their primary diagnoses (e.g., communication, adaptive behaviors, and social skills) are prevalent in atypically developing populations and are significant predictors of quality of life. Therefore, the purpose of the current study was to examine impairments in socialization and nonverbal communication in individuals with Down's syndrome (DS), CP, and those with CP and comorbid ASD. Individuals with comorbid CP and ASD exhibited significantly greater impairments than any diagnostic group alone. However, individuals with CP also exhibited significantly greater impairments than those with DS. The implications of these results are discussed.
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Bartlett DJ, Chiarello LA, McCoy SW, Palisano RJ, Jeffries L, Fiss AL, Wilk P. Determinants of self-care participation of young children with cerebral palsy. Dev Neurorehabil 2014; 17:403-13. [PMID: 24725221 DOI: 10.3109/17518423.2014.897398] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To test a model of child, family and service determinants of self-care participation of children with cerebral palsy (CP), grouped by Gross Motor Function Classification System levels (I-II and III-V). METHODS Participants were a convenience sample of 429 children (242 males) with CP, aged 18-60 months. Data on impairments and gross motor function were collected by reliable therapists; parents provided information about children's health conditions and adaptive behaviour. Seven months later parents reported on family life and services received. One year after study onset, parents documented children's self-care participation. Data from two groups of children were analysed using structural equation modelling. RESULTS The model explained a significant proportion of the variance of self-care participation, with higher motor function, fewer health conditions and higher levels of adaptive behaviour being associated with greater self-care participation. CONCLUSION Supporting children's gross motor function, health and adaptive behaviour may optimize self-care participation.
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Affiliation(s)
- Doreen J Bartlett
- School of Physical Therapy, Western University , London, ON , Canada
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Shikako-Thomas K, Kolehmainen N, Ketelaar M, Bult M, Law M. Promoting leisure participation as part of health and well-being in children and youth with cerebral palsy. J Child Neurol 2014; 29:1125-33. [PMID: 24907136 DOI: 10.1177/0883073814533422] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 11/15/2022]
Abstract
Participation in leisure is a human right and is central to the health of children and youth. The World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth supported a change in thinking about what outcomes are most relevant in the context of children's health and places participation as one of the constituent elements of health. Participation is also a fundamental rehabilitation and health promotion outcome for children with cerebral palsy as identified by youth, parents, and health professionals. Several studies have identified individual and environmental factors related to participation in leisure; new studies are now determining the best interventions to promote participation. This article summarizes recent findings and proposes important topics for neurologists to consider in exploring leisure pursuits with children with cerebral palsy and their families and in working with rehabilitation professionals to promote engagement in leisure opportunities as part of integrated care.
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Affiliation(s)
- Keiko Shikako-Thomas
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| | - Niina Kolehmainen
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, United Kingdom
| | - Marjolijn Ketelaar
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine University Medical Center Utrecht and De Hoogstraat Rehabilitation, the Netherlands Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, the Netherlands
| | - Maureen Bult
- Utrecht University, Faculty of Social Sciences, Department of Pedagogical and Educational Sciences, Utrecht, the Netherlands
| | - Mary Law
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
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James S, Ziviani J, Boyd R. A systematic review of activities of daily living measures for children and adolescents with cerebral palsy. Dev Med Child Neurol 2014; 56:233-44. [PMID: 23937056 DOI: 10.1111/dmcn.12226] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to systematically review the psychometric properties and clinical utility of measures of activities of daily living (ADL) for children with cerebral palsy (CP) aged 5 to 18 years. METHOD Five electronic databases were searched to identify available ADL measures with published psychometric data for school-aged children with CP. Measures were included if at least 60% of the items addressed ADL in the full assessment or in an independent domain. A modified CanChild Outcome Rating Form was used to report the validity, reliability, responsiveness, and clinical utility of the measures. RESULTS Twenty-six measures were identified and eight met inclusion criteria. The Pediatric Evaluation of Disability Inventory (PEDI) had the strongest psychometric properties but was limited by its age range. The Assessment of Motor and Process Skills (AMPS) was the most comprehensive evaluation of underlying motor and cognitive abilities yet further psychometric testing is required for children with CP. INTERPRETATION The PEDI should be used to measure ADL capability in elementary school aged children. The AMPS is the best measure to evaluate ADL performance or capacity and is suitable for all ages. Future research should examine the reliability of the AMPS to determine its stability in children and adolescents with CP.
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Affiliation(s)
- Sarah James
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Royal Children's Hospital, Brisbane, Qld, Australia
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Phipps S, Roberts P. Predicting the effects of cerebral palsy severity on self-care, mobility, and social function. Am J Occup Ther 2013; 66:422-9. [PMID: 22742690 DOI: 10.5014/ajot.2012.003921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this retrospective, longitudinal cohort study, the Pediatric Evaluation of Disability Inventory was used to predict the effects of cerebral palsy (CP) on self-care, mobility, and social function for 2,768 children, adolescents, and young adults with CP. Multiple linear regression was used to predict functional performance and level of caregiver assistance and found that CP severity, as measured by the Gross Motor Function Classification System and the Manual Ability Classification System, had the strongest effect. More severe levels of gross motor and fine motor dysfunction resulted in lower levels of self-care, mobility, and social function and increased levels of caregiver assistance. This study provides critical evidence regarding the importance of CP severity as a predictor of self-care, mobility, and social function that can be tested in future research to improve therapy treatment planning, caregiver education, and clinical resource utilization.
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Affiliation(s)
- Shawn Phipps
- Rancho Los Amigos National Rehabilitation Center, 7601 East Imperial Highway, Downey, CA 90242, USA.
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van Schie PEM, Siebes RC, Dallmeijer AJ, Schuengel C, Smits DW, Gorter JW, Becher JG. Development of social functioning and communication in school-aged (5-9 years) children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4485-4494. [PMID: 24139717 DOI: 10.1016/j.ridd.2013.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/15/2013] [Accepted: 09/19/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to examine determinants of the course and level of social functioning and communication in school-aged children with cerebral palsy (CP) over a 2-year period. A clinic-based sample of 5 and 7 years old children with CP (n=108; 72 males; mean age 6 y 3 mo, SD 12 mo; Gross Motor Function Classification System (GFMCS) level I-V) was followed longitudinally in three yearly assessments. Social functioning and communication were measured with the Vineland Adaptive Behavior Scales (VABS). Data were analyzed with generalized estimated equations. The results showed that social function followed a course of progressive restrictions over time in non-ambulatory children with CP aged 5-9 compared to children who could walk with or without walking aids. Overall lower levels of social functioning were found in children with GMFCS V, epilepsy, speech problems, lower intellectual capacity and older age at baseline. For communication more restrictions over time were found in children with lower intellectual capacity. Children with GMFCS V, speech problems and older age at baseline had overall greater restrictions in communication. It was concluded that motor functioning and intellectual ability can be used to identify children at risk for progressive restrictions in social functioning and communication. For children with CP and social and communicative restrictions, multidisciplinary assessment and treatment may be indicated to counteract an unfavorable development.
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Affiliation(s)
- Petra E M van Schie
- VU University Medical Center, Department of Rehabilitation Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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Novak I. Evidence to practice commentary: advancing the evidence and the right to participation. Phys Occup Ther Pediatr 2013; 33:421-5. [PMID: 24032671 DOI: 10.3109/01942638.2013.834179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, School of Medicine, University of Notre Dame Australia, Darlinghurst NSW, Australia
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Cheong SK, Johnston LM. Systematic review of self-concept measures for primary school aged children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3566-3575. [PMID: 23962603 DOI: 10.1016/j.ridd.2013.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/12/2013] [Accepted: 07/15/2013] [Indexed: 06/02/2023]
Abstract
This study involved a systematic review aimed to identify self-concept measures that provided published psychometrics for primary school aged children (8-12 years) with cerebral palsy (CP). Six electronic databases (PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Web of Science) were searched to identify assessments that (1) measured self-concept; (2) in children aged 8-12 years; (3) with CP; (4) with psychometrics available. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to evaluate psychometric properties and the CanChild Outcome Measure Rating Form was used to evaluate clinical utility. Search yielded 271 papers, of which five met inclusion criteria. These papers reported five measures of self-concept with psychometric properties for the target population: the Rosenberg Self-Esteem Index, Self-Description Questionnaire-I, Self-Perception Profile for Children (original) and two separate modifications of the Self-Perception Profile for Children. Currently, no self-concept measures published in English had sufficient psychometric data for children with CP. The Self-Description Questionnaire-I and the Self-Perception Profile for Children were promising options. Further research is required (a) to determine self-concept construct components important for children with CP and (b) to examine the relative strength, validity, reliability and clinical utility of self-concept measures for the target population.
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Affiliation(s)
- Sau Kuan Cheong
- School of Psychology, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia.
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Capacity to participation in cerebral palsy: evidence of an indirect path via performance. Arch Phys Med Rehabil 2013; 94:2365-2372. [PMID: 23835350 DOI: 10.1016/j.apmr.2013.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/30/2013] [Accepted: 06/13/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the hypothesis that the influence of physical activity capacity on participation is mediated through activity performance. DESIGN Secondary analysis of a prospective cross-sectional study sample. SETTING Regional pediatric specialty care hospital. PARTICIPANTS Children (N=128; 59% boys; age range, 2-9y) with cerebral palsy with Gross Motor Function Classification System levels I to III; 49% had hemiplegia, and 72% had spasticity. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activity capacity was measured with the Gross Motor Function Measure-66, performance was measured with the Activities Scale for Kids, and participation was measured with the Assessment of Life Habits. Children's Assessment of Participation and Enjoyment and the Assessment of Preschool Children's Participation assessed diversity participation. Regression equations and Sobel z test were used to examine the mediated effect via performance. RESULTS Physical activity performance mediates 74.9% (β=.83, P<.001) of the effect of activity capacity on total participation levels and 52.8% (β=.47, P=.001) of the effect of capacity on diversity participation. CONCLUSIONS The relation between what an ambulatory child with cerebral palsy is able to perform in a clinical setting and their participation in life is significantly mediated by what they actually do motorically in day-to-day life. Results suggest that interventions focusing on improving what they actually do every day, regardless of their capacity to perform (what they can do when tested), may positively influence participation.
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Coleman A, Weir KA, Ware RS, Boyd RN. Relationship between communication skills and gross motor function in preschool-aged children with cerebral palsy. Arch Phys Med Rehabil 2013; 94:2210-7. [PMID: 23583864 DOI: 10.1016/j.apmr.2013.03.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 03/25/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the communication skills of children with cerebral palsy (CP) at 24 months' corrected age with reference to typically developing children, and to determine the relationship between communication ability, gross motor function, and other comorbidities associated with CP. DESIGN Prospective, cross-sectional, population-based cohort study. SETTING General community. PARTICIPANTS Children with CP (N=124; mean age, 24mo; functional severity on Gross Motor Function Classification System [GMFCS]: I=47, II=14, III=22, IV=19, V=22). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Parents reported communication skills on the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Two independent physiotherapists classified motor type, distribution, and GMFCS. Data on comorbidities were obtained from parent interviews and medical records. RESULTS Children with mild CP (GMFCS I/II) had mean CSBS-DP scores that were 0.5 to 0.6 SD below the mean for typically developing peers, while those with moderate-severe impairment (GMFCS III-V) were 1.4 to 2.6 SD below the mean. GMFCS was significantly associated with performance on the CSBS-DP (F=18.55, P<.001), with gross motor ability accounting for 38% of the variation in communication. Poorer communication was strongly associated with gross motor function and full-term birth. CONCLUSIONS Preschool-aged children with CP, with more severe gross motor impairment, showed delayed communication, while children with mild motor impairment were less vulnerable. Term-born children had significantly poorer communication than those born prematurely. Because a portion of each gross motor functional severity level is at risk, this study reinforces the need for early monitoring of communication development for all children with CP.
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Affiliation(s)
- Andrea Coleman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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Meinzen-Derr J, Wiley S, Grether S, Choo DI. Functional performance among children with cochlear implants and additional disabilities. Cochlear Implants Int 2013; 14:181-9. [PMID: 23407115 DOI: 10.1179/1754762812y.0000000019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess daily functional skills among young cochlear implant (CI) recipients with additional disabilities. METHODS Children with CI and developmental disabilities and a hearing control group containing similar ages and similar disabilities were enrolled in a cross-sectional study of language and functional skills. Daily functional skills were measured using the Pediatric Evaluation of Disability Inventory (PEDI), which provides standard and scaled scores in Self-Care, Mobility, and Social Functioning domains. Language was assessed using the Preschool Language Scales, 4th edition which provides standard scores and age equivalents. RESULTS Fourteen children with CIs and seven hearing controls were included in this analysis. Most children in this study (90.5%) had cognitive disabilities and 57% had motor disabilities. Compared with the hearing controls, children with CIs were less likely to have functional independence in any PEDI domain. Children with CI had significantly lower median social functioning standard scores compared with controls (17.3 vs. 27.5, P = 0.009). After controlling for nonverbal cognitive abilities and language level, the difference was no longer significant (19.1 vs. 24, P = 0.3). Among children with CI, age at implant and duration with device were not associated (P > 0.4) with PEDI scores. DISCUSSION Although children with CI and developmental disabilities had similar functional skills as hearing children with similar disabilities regarding the PEDI domains of Self-Care and Mobility, they had lower Social Function standard scores. This lower social functioning among children with implants may be related to lower language levels and possible language deficits seen in the CI group. Regular assessments of functional abilities coupled with language abilities are essential in providing every child with the opportunity for maximizing the potential for independence.
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Affiliation(s)
- Jareen Meinzen-Derr
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, USA.
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38
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Pereira Da Costa M, Scelles R. Un outil d’évaluation des compétences cognitives des jeunes polyhandicapés : le P2CJP. ALTER-EUROPEAN JOURNAL OF DISABILITY RESEARCH 2012. [DOI: 10.1016/j.alter.2012.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bult MK, Verschuren O, Jongmans MJ, Lindeman E, Ketelaar M. What influences participation in leisure activities of children and youth with physical disabilities? A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1521-1529. [PMID: 21388783 DOI: 10.1016/j.ridd.2011.01.045] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 05/30/2023]
Abstract
In 2001 the International Classification of Functioning (ICF) defined participation as 'someone's involvement in life situations'. Participation in leisure activities contributes to the development of children and their quality of life. Children with physical disabilities are known to be at risk for participation in fewer activities. The group of children with physical disabilities is highly heterogeneous consisting of children with different diagnosis and different ages. This systematic review aims to analyse the literature for the purpose of looking for variables involved in the frequency of participation in leisure activities for children and youth with different diagnoses and ages. Frequency of participation in leisure activities for children and youth with physical disabilities is associated with a variety of variables. Gross motor function, manual ability, cognitive ability, communicative skills, age and gender are the most important variables. The current evidence suggests that similar variables seem to apply to children with different diagnoses. Age is an important variable in participation of children and youth. However evidence about those variables associated with children at different ages is still lacking.
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Affiliation(s)
- M K Bult
- Rehabilitation Centre De Hoogstraat, Centre of Excellence for Rehabilitation Medicine, Rembrandtkade10, 3583 TM, Utrecht, The Netherlands
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Ben-Pazi H. Trihexyphenidyl improves motor function in children with dystonic cerebral palsy: a retrospective analysis. J Child Neurol 2011; 26:810-6. [PMID: 21498790 DOI: 10.1177/0883073810392582] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are conflicting reports regarding the efficacy of trihexyphenidyl, an anticholinergic drug, for treatment of dystonia in cerebral palsy. The author hypothesized that trihexyphenidyl may be more effective in specific subgroups and performed a retrospective analysis of 31 children (8.2 ± 5.8 years) with dystonia following treatment with high-dose trihexyphenidyl (>0.5 mg/kg/day). Main outcome measure was extent of motor improvement calculated according to the body areas affected. Most (21/31) caregivers reported improvement in 1 or more areas, mainly arm, hand, and oromotor function. Improvement was greater in children without spasticity (P = .02) and in those with higher cognitive function (P = .02). While a third of caregivers (10/31) reported tone reduction, and half (15/31) noted overall functional improvement. Side effects were transient, with the exception of hyperopia (n = 1), and occurred less frequently in children with a history of prematurity (P = .02). In summary, trihexyphenidyl is effective particularly in absence of spasticity and in children with higher cognitive abilities.
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Affiliation(s)
- Hilla Ben-Pazi
- Movement Disorder Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Smits DW, Ketelaar M, Gorter JW, van Schie PE, Becher JG, Lindeman E, Jongmans MJ. Development of non-verbal intellectual capacity in school-age children with cerebral palsy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:550-562. [PMID: 21435067 DOI: 10.1111/j.1365-2788.2011.01409.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) are at greater risk for a limited intellectual development than typically developing children. Little information is available which children with CP are most at risk. This study aimed to describe the development of non-verbal intellectual capacity of school-age children with CP and to examine the association between the development of non-verbal intellectual capacity and the severity of CP. METHODS A longitudinal analysis in a cohort study was performed with a clinic-based sample of children with CP. Forty-two children were assessed at 5, 6 and 7 years of age, and 49 children were assessed at 7, 8 and 9 years of age. Non-verbal intellectual capacity was assessed by Raven's Coloured Progressive Matrices (RCPM). Severity of CP was classified by the Gross Motor Function Classification System, type of motor impairment and limb distribution. manova for repeated measurements was used to analyse time effects and time × group effects on both RCPM raw scores and RCPM intelligence quotient scores. RESULTS The development of non-verbal intellectual capacity was characterised by a statistically significant increase in RCPM raw scores but no significant change in RCPM intelligence quotient scores. The development of RCPM raw scores was significantly associated with the severity of CP. Children with higher levels of gross motor functioning and children with spastic CP showed greater increase in raw scores than children with lower levels of gross motor functioning and children with dyskinetic CP. CONCLUSIONS Children with CP aged between 5 and 9 years show different developmental trajectories for non-verbal intellectual capacity, which are associated with the severity of CP. The development of non-verbal intellectual capacity in children with less severe CP seems to resemble that of typically developing children, while children with more severe CP show a limited intellectual development compared to typically developing children.
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Affiliation(s)
- D W Smits
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
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Chiarello LA, Palisano RJ, Bartlett DJ, McCoy SW. A multivariate model of determinants of change in gross-motor abilities and engagement in self-care and play of young children with cerebral palsy. Phys Occup Ther Pediatr 2011; 31:150-68. [PMID: 20964514 DOI: 10.3109/01942638.2010.525601] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A multivariate model of determinants of change in gross-motor ability and engagement in self-care and play provides physical and occupational therapists a framework for decisions on interventions and supports for young children with cerebral palsy and their families. Aspects of the child, family ecology, and rehabilitation and community services may influence children's activity and participation. Aspects of the child include primary and secondary impairments, associated and comorbid health conditions, and adaptive behaviors. Literature support for the model is reviewed. A clinical scenario illustrates the use of the model as a framework for practice. The model encourages therapists to broaden the focus of rehabilitation services for young children with CP to include not only development of motor abilities but also comprehensive interventions and supports to enhance participation in daily activities and routines. Therapists are encouraged to consider how child, family, and service factors interact when planning interventions and evaluating outcomes.
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Affiliation(s)
- Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania 19102, USA.
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Stahlhut M, Gard G, Aadahl M, Christensen J. Discriminative validity of the Danish version of the Pediatric Evaluation of Disability Inventory (PEDI). Phys Occup Ther Pediatr 2011; 31:78-89. [PMID: 20735194 DOI: 10.3109/01942638.2010.486824] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Pediatric Evaluation of Disability Inventory (PEDI) assesses functional status in children with disabilities aged 0.5-7.5 years. The purpose of this study was to examine if the Danish version of the PEDI was able to discriminate between nondisabled children and children with cerebral palsy (CP) or juvenile idiopathic arthritis (JIA). Convenience sampling was used to select the clinical samples that consisted of 22 children with CP and 14 children with JIA aged 1.5-7.5 years. An additional sample, consisting of 224 nondisabled children aged 1.0-5.9 years, was obtained on the basis of random sampling. The PEDI was administered as a questionnaire completed by the parents. Results from receiver operating characteristics (ROC) analysis showed that in the case of discrimination between children with CP and nondisabled children, the sensitivity and specificity were 77.3 and 97.8%, respectively. In the discrimination between children with JIA and nondisabled children, the sensitivity and specificity were 99.8 and 81.7%, respectively. Study results indicate that the Danish version of the PEDI shows good discriminative validity. Further studies of the discriminative validity are recommended.
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Affiliation(s)
- Michelle Stahlhut
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
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Smits DW, Ketelaar M, Gorter JW, van Schie P, Dallmeijer A, Jongmans M, Lindeman E. Development of daily activities in school-age children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:222-234. [PMID: 21041062 DOI: 10.1016/j.ridd.2010.09.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 09/28/2010] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to describe the course of capabilities in self-care, mobility, and social function in school-age children with cerebral palsy (CP) and to investigate associations with CP-, child-, and family-characteristics. A clinic-based sample of children with CP (n = 116; 76 males, 40 females; mean age 6 y 3 mo, SD 12 mo) was followed longitudinally in three yearly measurements. Children's capabilities were assessed with the Pediatric Evaluation of Disability Inventory Functional Skills Scale (PEDI-FSS). Averaged for the total group, significant increases over time were shown in PEDI-FSS scores in all three domains. For self-care, the course was best predicted by a model including level of gross motor function (measured by the Gross Motor Function Classification System) and intellectual capacity (measured by Raven's Coloured Progressive Matrices). For mobility, the course was best predicted by a model containing only level of gross motor function. For social function, the course was best predicted by a model comprising level of bimanual function (measured by the Manual Ability Classification System) and paternal educational level. Generally, the increase in capabilities was greater if level of functioning was higher, except for level of paternal education. The findings indicate that there are different sets of determinants for the course of different domains of daily activities. Such different sets of determinants may help to set realistic expectations and to create appropriate treatment plans for different domains of daily activities in school-age children with CP.
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Affiliation(s)
- Dirk-Wouter Smits
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
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45
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Kerr C, McDowell BC, Parkes J, Stevenson M, Cosgrove AP. Age-related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy. Dev Med Child Neurol 2011; 53:61-7. [PMID: 20875041 DOI: 10.1111/j.1469-8749.2010.03795.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to use a prospective longitudinal study to describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP). METHOD Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4-16y) with CP. Ninety-four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty-seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment. RESULTS Significant improvements in mean raw scores for GMFM, PEDI, and LAQ-CP were recorded; however, mean raw oxygen cost deteriorated over time. Age-related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (κ(lw) =0.74-0.76). INTERPRETATION These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.
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Affiliation(s)
- Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
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Tseng MH, Chen KL, Shieh JY, Lu L, Huang CY. The determinants of daily function in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:235-245. [PMID: 21030207 DOI: 10.1016/j.ridd.2010.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/28/2010] [Indexed: 05/30/2023]
Abstract
The aim of this study was to identify determinants of daily function in a population-based sample of children with cerebral palsy (CP). The study took into consideration factors from the entire scope of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, the determinants of daily function were examined from the perspectives of capacity and performance respectively. A total of 216 children with CP (mean age 8.19 years, SD 3.39 years) and their caregivers participated in the study. The potential determinants of daily function from the dimensions of health condition, body functions and structures, environmental and personal factors of the ICF were collected. Stepwise multiple regression models showed that child's age, grade, preferred hand, educational placement, severity of gross and fine motor impairment, and prosocial behavior were important determinants, accounting for 88.29% of the variance of daily capacity. The aforementioned variables together with birth order were determinants of performance of daily function, and accounted for 89.53% of the variance in that performance. Knowledge of determinants of daily function helps clinicians and educators to plan intervention and educational programs targeted at these determinants to improve capacity and performance in daily function for children with CP.
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Affiliation(s)
- Mei-Hui Tseng
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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47
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Benedict RE, Patz J, Maenner MJ, Arneson CL, Yeargin-Allsopp M, Doernberg NS, Van Naarden Braun K, Kirby RS, Durkin MS. Feasibility and reliability of classifying gross motor function among children with cerebral palsy using population-based record surveillance. Paediatr Perinat Epidemiol 2011; 25:88-96. [PMID: 21133973 DOI: 10.1111/j.1365-3016.2010.01164.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For conditions with wide-ranging consequences, such as cerebral palsy (CP), population-based surveillance provides an estimate of the prevalence of case status but only the broadest understanding of the impact of the condition on children, families or society. Beyond case status, information regarding health, functional skills and participation is necessary to fully appreciate the consequences of the condition. The purpose of this study was to assess the feasibility and reliability of enhancing population-based surveillance by classifying gross motor function (GMF) from information available in medical records of children with CP. We assessed inter-rater reliability of two GMF classification methods, one the Gross Motor Function Classification System (GMFCS) and the other a 3-category classification of walking ability: (1) independently, (2) with handheld mobility device, or (3) limited or none. Two qualified clinicians independently reviewed abstracted evaluations from medical records of 8-year-old children residing in southeast Wisconsin, USA who were identified as having CP (n = 154) through the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. Ninety per cent (n = 138) of the children with CP had information in the record after age 4 years and 108 (70%) had adequate descriptions of gross motor skills to classify using the GMFCS. Agreement was achieved on 75.0% of the GMFCS ratings (simple kappa = 0.67, 95% confidence interval [95% CI 0.57, 0.78], weighted kappa = 0.83, [95% CI 0.77, 0.89]). Among case children for whom walking ability could be classified (n = 117), approximately half walked independently without devices and one-third had limited or no walking ability. Across walking ability categories, agreement was reached for 94% (simple kappa = 0.90, [95% CI 0.82, 0.96], weighted kappa = 0.94, [95% CI 0.89, 0.98]). Classifying GMF in the context of active records-based surveillance is feasible and reliable. Future surveillance efforts that include functional level among children with cerebral palsy may provide important information for monitoring the impact of the condition for programmatic and policy purposes.
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Affiliation(s)
- Ruth E Benedict
- Waisman Center, Department of Kinesiology, University of Wisconsin, Madison, WI 53706-1532, USA.
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48
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Ketelaar M, Kruijsen AJA, Verschuren O, Jongmans MJ, Gorter JW, Verheijden J, Reinders-Messelink HA, Lindeman E. LEARN 2 MOVE 2-3: a randomized controlled trial on the efficacy of child-focused intervention and context-focused intervention in preschool children with cerebral palsy. BMC Pediatr 2010; 10:80. [PMID: 21059257 PMCID: PMC2989309 DOI: 10.1186/1471-2431-10-80] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 11/08/2010] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP). In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years) with CP and their families: a child-focused intervention approach and a context-focused intervention approach. Methods/Design A multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS) level I-IV; age 2 to 3 years), their parents, and service providers (physical and occupational therapists) will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI). Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY), including body function and structure, activities (gross motor capacity and performance of daily activities), social participation, environmental variables (family functioning, parental empowerment). Discussion This paper presents the background information, design, description of interventions and protocol for this study on the efficacy and working mechanisms of child-focused intervention approach and context-focused intervention approach compared to regular care intervention in mobility and self-care skills of children (2-3 years) with CP. Trial registration This study is registered in the Dutch Trial Register as NTR1900
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Affiliation(s)
- Marjolijn Ketelaar
- Rehabilitation Center De Hoogstraat, Center of Excellence for Rehabilitation Medicine Utrecht, Utrecht, the Netherlands.
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Partizipation von 8- bis 12-jährigen Kindern mit Zerebralparese in Schleswig-Holstein. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Öhrvall AM, Eliasson AC, Löwing K, Ödman P, Krumlinde-Sundholm L. Self-care and mobility skills in children with cerebral palsy, related to their manual ability and gross motor function classifications. Dev Med Child Neurol 2010; 52:1048-55. [PMID: 20722662 DOI: 10.1111/j.1469-8749.2010.03764.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to investigate the acquisition of self-care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function. METHOD Data from the Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8 y 1 mo; SD 3 y 11 mo; range 3-15 y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively. RESULTS Children classified as MACS and GMFCS levels I or II scored higher than children in MACS and GMFCS levels III to V on both the self-care and mobility domains of the PEDI, with significant differences between all classification levels (p<0.001). The stepwise multiple regression analysis verified that MACS was the strongest predictor of self-care skills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self-care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age. INTERPRETATION Knowledge of a child's MACS and GMFCS level can be useful when discussing expectations of, and goals for, the development of functional skills.
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Affiliation(s)
- Ann-Marie Öhrvall
- Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
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