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Makaram NS, Prescott RJ, Alexander P, Robb JE, Gaston MS. Validation of a modified Care and Comfort Score and responsiveness to hip surgery in children with cerebral palsy in Gross Motor Function Classification System levels IV and V. Bone Jt Open 2023; 4:580-583. [PMID: 37558227 PMCID: PMC10412107 DOI: 10.1302/2633-1462.48.bjo-2023-0051.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
AIMS The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V. METHODS This was a population-based cohort study in children with CP from a national surveillance programme. Reliability was assessed from 20 caregivers who completed the mCCHQ questionnaire on two occasions three weeks apart. Test-retest reliability of the mCCHQ was calculated, and responsiveness before and after surgery for a displaced hip was evaluated in a cohort of children. RESULTS Test-retest reliability for the overall mCCHQ score was good (intraclass correlation coefficient 0.78), and no dimension demonstrated poor reliability. The surgical intervention cohort comprised ten children who had preoperative and postoperative mCCHQ scores at a minimum of six months postoperatively. The mCCHQ tool demonstrated a significant improvement in overall score from preoperative assessment to six-month postoperative follow-up assessment (p < 0.001). CONCLUSION The mCCHQ demonstrated responsiveness to intervention and good test-retest reliability. The mCCHQ is proposed as an outcome tool for use within a national surveillance programme for children with CP.
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Affiliation(s)
- Navnit S. Makaram
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | | | - Phyllida Alexander
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
| | - James E. Robb
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Mark S. Gaston
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
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Hernandez CM, McQuail JA, Ten Eyck TW, Wheeler AR, Labiste CC, Setlow B, Bizon J. GABA B receptors in prelimbic cortex and basolateral amygdala differentially influence intertemporal decision making and decline with age. Neuropharmacology 2022; 209:109001. [PMID: 35189132 DOI: 10.1016/j.neuropharm.2022.109001] [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: 01/03/2022] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
The ability to decide adaptively between immediate vs. delayed gratification (intertemporal choice) is critical for well-being and is associated with a range of factors that influence quality of life. In contrast to young adults, many older adults show enhanced preference for delayed gratification; however, the neural mechanisms underlying this age difference in intertemporal choice are largely un-studied. Changes in signaling through GABAB receptors (GABABRs) mediate several age-associated differences in cognitive processes linked to intertemporal choice. The current study used a rat model to determine how GABABRs in two brain regions known to regulate intertemporal choice (prelimbic cortex; PrL and basolateral amygdala; BLA) contribute to age differences in this form of decision making in male rats. As in humans, aged rats showed enhanced preference for large, delayed over small, immediate rewards during performance in an intertemporal choice task in operant test chambers. Activation of PrL GABABRs via microinfusion of the agonist baclofen increased choice of large, delayed rewards in young adult rats but did not influence choice in aged rats. Conversely, infusion of baclofen into the BLA strongly reduced choice of large, delayed rewards in both young adult and aged rats. Aged rats further showed a significant reduction in expression of GABABR1 subunit isoforms in the prefrontal cortex, a discovery that is consonant with the null effect of intra-PrL baclofen on intertemporal choice in aged rats. In contrast, expression of GABABR subunits was generally conserved with age in the BLA. Jointly, these findings elucidate a role for GABABRs in intertemporal choice and identify fundamental features of brain maturation and aging that mediate an improved ability to delay gratification.
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Affiliation(s)
- Caesar M Hernandez
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA; Department of Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA; McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Joseph A McQuail
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA; Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine - Columbia, Columbia, SC, 29208, USA
| | - Tyler W Ten Eyck
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA
| | - Alexa-Rae Wheeler
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA
| | - Chase C Labiste
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA.
| | - Barry Setlow
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA; Department of Psychiatry, University of Florida, Gainesville, FL, 32610, USA; McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Jennifer Bizon
- Department of Neuroscience, University of Florida, Gainesville, FL, 32610, USA; McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA
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Stewart K, Copeland L, Lewis J. The Impact of Intrathecal Baclofen Therapy on Health-related Quality of Life for Children with Marked Hypertonia. Dev Neurorehabil 2020; 23:542-547. [PMID: 32338172 DOI: 10.1080/17518423.2020.1753841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the effects of intrathecal baclofen therapy (ITB) on health-related quality of life for children with cerebral palsy and neurological conditions. Method: This study is part of a longitudinal, multicentre audit. The primary outcome measure, the Caregiver Priorities and Child Health Index of Life with Disabilities, was completed at baseline, 6 and 12 months post ITB implant. Results: Forty subjects with cerebral palsy and other neurological conditions demonstrated significant improvement in aspects of health-related quality of life following ITB therapy, mean change 42.3 (SD 14.9) at baseline to 53.3 (SD 14.7) at 12 months (p< .001). Conclusion: Evidence to demonstrate the utility of ITB in pediatric populations beyond spasticity and dystonia reduction is limited. Our findings suggest that ITB improves aspects of quality of life, comfort, and ease of caregiving in children with cerebral palsy and other neurological conditions.
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Affiliation(s)
- Kirsty Stewart
- Kids Rehab, The Children's Hospital at Westmead , Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney , Sydney, Australia
| | - Lisa Copeland
- Queensland Children's Hospital , Brisbane, Australia
| | - Jennifer Lewis
- Kids Rehab, The Children's Hospital at Westmead , Sydney, Australia.,Queensland Children's Hospital , Brisbane, Australia.,Royal Children's Hospital , Melbourne, Australia.,Monash Children's Health , Melbourne, Australia.,Women and Children's Hospital , Adelaide, South Australia.,Perth Children's Hospital , Perth, Australia
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Ben-Pazi H, Aran A, Pandyan A, Gelkop N, Ginsberg G, Pollak Y, Elnatan D. Auditory stimulation improves motor function and caretaker burden in children with cerebral palsy- A randomized double blind study. PLoS One 2018; 13:e0208792. [PMID: 30543665 PMCID: PMC6292588 DOI: 10.1371/journal.pone.0208792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the impact of auditory stimulation on motor function in children with cerebral palsy (CP) and disabling hypertonia. Method 9 matched pairs (age: 7y5m, SD 4y1m; 13 boys; gross-motor-functional-classification-scale: median 4; manual-ability-classification-system: median 4) were randomized to receive either auditory stimulation embedded in music (study, n = 9) or music alone (sham, control, n = 9) for at least 10 minutes 4 times a week for 4 weeks. Goal-Attainment-Scale, Care-and-Comfort-Hypertonicity-Questionnaire, Gross-Motor-Function–Measure and Quality-of-Upper-Extremity-Skills-Test (QUEST) were assessed before and 5 months following intervention. Result Children receiving auditory stimulation attained more goals than children who listened to music alone (p = 0.002). Parents reported improved care and comfort in children in the study group compared to a slight deterioration in controls (p = 0.002). Upper extremity skills improved in the study group compared to controls (p = 0.006). Similar gross motor function changes were documented in both groups (p = 0.41). One participant reported increased seizure frequency; no other participants with epilepsy reported increased seizure frequency (n = 6/18) and no other adverse events were reported. Interpretation Auditory stimulation alleviated hypertonia and improved fine and gross motor functions.
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Affiliation(s)
- Hilla Ben-Pazi
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University, Keele, United Kingdom
| | - Nava Gelkop
- Physical therapy, Keren-Or Center, Jerusalem, Israel
- Meshi Children's Rehabilitation Center, Jerusalem, Israel
| | | | - Yehuda Pollak
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debby Elnatan
- Meshi Children's Rehabilitation Center, Jerusalem, Israel
- * E-mail:
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Programmable baclofen pump implantation as a treatment modality for spasticity: A clinical prospective study. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Maneyapanda MB, McCormick ZL, Marciniak C, Reger C. Long-Term Dosing of Intrathecal Baclofen in the Treatment of Spasticity After Acquired Brain Injury. PM R 2017; 9:556-562. [DOI: 10.1016/j.pmrj.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/12/2023]
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Beas BS, Setlow B, Bizon JL. Effects of acute administration of the GABA(B) receptor agonist baclofen on behavioral flexibility in rats. Psychopharmacology (Berl) 2016; 233:2787-97. [PMID: 27256354 PMCID: PMC4919234 DOI: 10.1007/s00213-016-4321-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/09/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE The ability to adjust response strategies when faced with changes in the environment is critical for normal adaptive behavior. Such behavioral flexibility is compromised by experimental disruption of cortical GABAergic signaling, as well as in conditions such as schizophrenia and normal aging that are characterized by cortical hyperexcitability. The current studies were designed to determine whether stimulation of GABAergic signaling using the GABA(B) receptor agonist baclofen can facilitate behavioral flexibility. METHODS Male Fischer 344 rats were trained in a set-shifting task in which they learned to discriminate between two response levers to obtain a food reward. Correct levers were signaled in accordance with two distinct response rules (rule 1: correct lever signaled by a cue light; rule 2: correct lever signaled by its left/right position). The order of rule presentation varied, but they were always presented sequentially, with the trials and errors to reach criterion performance on the second (set shift) rule providing the measure of behavioral flexibility. Experiments determined the effects of the GABA(B) receptor agonist baclofen (intraperitoneal, 0, 1.0, 2.5, and 4.0 mg/kg) administered acutely before the shift to the second rule. RESULTS Baclofen enhanced set-shifting performance. Control experiments demonstrated that this enhancement was not simply due to improved discrimination learning, nor was it due to impaired recall of the initial discrimination rule. CONCLUSIONS The results demonstrate that baclofen can facilitate behavioral flexibility, suggesting that GABA(B) receptor agonists may have utility for treating behavioral dysfunction in neuropsychiatric disorders.
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Affiliation(s)
- B. Sofia Beas
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL
| | - Barry Setlow
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL,Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL
| | - Jennifer L. Bizon
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, FL,Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL
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Abstract
Tone management is one of the primary roles of a pediatric physiatrist. Hypertonicity frequently inhibits normal movement patterns in children with central nervous system lesions but at times can reinforce muscle group firing and be useful for a child's function. Treatment approaches should be individualized based on functional goals, degree of impairment, interference with care, and type and location of hypertonicity. Treatment plans should be created in collaboration with all individuals caring for the child. There are many causes of hypertonicity as well as many nonsurgical and surgical treatments. Historical and current evidence-based treatments are reviewed.
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Affiliation(s)
- Sathya Vadivelu
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, 3020 Children's Way MC5096, San Diego, CA 92123, USA
| | - Anne Stratton
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, USA
| | - Wendy Pierce
- Department of Physical Medicine and Rehabilitation, University of Colorado, 4125 Briargate Parkway, Box 520, Colorado Springs, CO 80920, USA.
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