1
|
Rosenberg L, Zecharia S, Gilboa Y, Golos A. Preparing Adults with Cerebral Palsy to Move from Assisted to Independent Living. Can J Occup Ther 2024:84174241274743. [PMID: 39238244 DOI: 10.1177/00084174241274743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Background. To evaluate effectiveness of The Greenhouse for autonomy and independence to prepare adults with severe cerebral palsy (CP) for the transition from assisted to independent living. The intervention combines weekly individual sessions using Pathways and Resources for Engagement and Participation together with weekly group sessions. Method. Seven adults with severe CP ages 23-45 years (M = 35; SD = 10) participated in the 20-week program. An Interrupted Time Series quasi-experimental design was used, assessing the intervention effect over time. The Canadian Occupational Performance Measure was administered bi-weekly from baseline to post-intervention to assess activity performance. Functional Independence Measure (FIM), Wheelchair use Confidence scale (WheelCon) and Impact on Participation and Autonomy (IPA) were administered baseline (4 weeks pre-intervention), mid and post-intervention, using Freidman test. Interviews were conducted four weeks after intervention. Findings. All participants' activity performance improved over time with significant clinical improvement in 95% of COPM goals. Significant improvement was seen in FIM (χ2 = 8.07, p = .018) and WheelCon (χ2 = 7.18, p = .028) though not in IPA. Participants described being better prepared, however more aware of challenges. Conclusion. The findings suggest the program may be effective to help adults with severe CP attain goals related to independent living and enhance function.
Collapse
|
2
|
Lindsay S, Ragunathan S, Fuentes K, Li Y. Barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families: a scoping review. Disabil Rehabil 2024; 46:3266-3285. [PMID: 37584404 DOI: 10.1080/09638288.2023.2246011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Accessible housing is a fundamental human right and yet many children and youth with disabilities live in inaccessible, insecure, unaffordable and poor quality housing. The aim of our study was to understand the barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families. METHODS We conducted a scoping review involving seven international literature databases from 2000 to 2022 that identified 38 studies meeting our inclusion criteria. RESULTS The reviewed studies involved 10 countries over a 22-year period. Our review emphasized the following key trends: (1) barriers to obtaining accessible homes (i.e. common types of accessibility barriers, rates of inaccessible housing, factors affecting home accessibility), and negative impacts of inaccessible housing; and (2) rates and facilitators to obtaining accessible housing (i.e., common types of home modifications, enablers of home modifications) and positive impacts of accessible housing. CONCLUSIONS Our findings highlight the barriers and enablers of obtaining accessible housing among children, youth and young adults with disabilities and their families and the critical need to support them in securing appropriate housing.
Collapse
Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| |
Collapse
|
3
|
Rosenberg L, Zecharia S, Gilboa Y, Golos A. Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy. Disabil Rehabil 2024:1-8. [PMID: 38591970 DOI: 10.1080/09638288.2024.2339535] [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: 09/24/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention. MATERIALS AND METHODS An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context. RESULTS Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living. CONCLUSIONS The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.
Collapse
Affiliation(s)
- Lori Rosenberg
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Shira Zecharia
- Occupational Therapy Department, Beit Finger of the Gravsky Rehabilitation Centre, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Anat Golos
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| |
Collapse
|
4
|
Lyster AE, Hansen SL, Andersen CT, Nielsen JB, Westerterp K, Wouters L, Kiens B, Ritterband-Rosenbaum A. Oral Motor Impairments Contribute to Weight Status of Adults with Severe Cerebral Palsy. Nutrients 2023; 15:5042. [PMID: 38140301 PMCID: PMC10745858 DOI: 10.3390/nu15245042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Adults with severe cerebral palsy (CP) are susceptible to malnutrition and metabolic disorders due to limited daily physical activity and challenges related to eating. We hypothesized that the condition of being underweight arises from inadequate energy intake due to difficulties in eating, rather than heightened total energy expenditure or an elevated resting metabolic rate. The present study encompassed 17 adults with severe CP (classified as GMFSC III-V). Energy intake, utilization, and expenditure were gauged via thorough dietary recordings and double-labeled water (DLW) analyses. Resting metabolic rates were assessed through indirect calorimetry, and metabolic health was investigated via blood samples. Oral motor function, eating assessment during meals, and weight fluctuations throughout the experimental period were also evaluated. We found significant correlations between weight, oral impairments (p < 0.01), and eating difficulties (p < 0.05). While total energy expenditure and daily consumption were similar between underweight (UW) and overweight (OW) individuals, significant variability in both expenditure and intake was evident within the UW group. Particularly, those with lower BMIs experienced heightened mealtime impairments and complications. Our present findings indicate that eating difficulties are the central concern for UW status in this population.
Collapse
Affiliation(s)
- Aslak Emil Lyster
- The August Krogh Section for Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen, Denmark; (A.E.L.); (B.K.)
| | - Solvejg Lis Hansen
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
| | | | - Jens Bo Nielsen
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Klaas Westerterp
- Department of Nutrition and Movement Sciences, The Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (K.W.); (L.W.)
| | - Loek Wouters
- Department of Nutrition and Movement Sciences, The Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (K.W.); (L.W.)
| | - Bente Kiens
- The August Krogh Section for Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Universitetsparken 13, 2100 Copenhagen, Denmark; (A.E.L.); (B.K.)
| | - Anina Ritterband-Rosenbaum
- Elsass Foundation, Holmegaardsvej 28, 2920 Charlottelund, Denmark; (S.L.H.); (C.T.A.); (J.B.N.)
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| |
Collapse
|
5
|
Malandraki GA, Mitchell SS, Hahn Arkenberg RE, Brown B, Craig BΑ, Burdo-Hartman W, Lundine JP, Darling-White M, Goffman L. Swallowing and Motor Speech Skills in Unilateral Cerebral Palsy: Novel Findings From a Preliminary Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3300-3315. [PMID: 35952392 PMCID: PMC9913219 DOI: 10.1044/2022_jslhr-22-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Our purpose was to start examining clinical swallowing and motor speech skills of school-age children with unilateral cerebral palsy (UCP) compared to typically developing children (TDC), how these skills relate to each other, and whether they are predicted by clinical/demographic data (age, birth history, lesion type, etc.). METHOD Seventeen children with UCP and 17 TDC (7-12 years old) participated in this cross-sectional study. Feeding/swallowing skills were evaluated using the Dysphagia Disorder Survey (DDS) and a normalized measure of mealtime efficiency (normalized mealtime duration, i.e., nMD). Motor speech was assessed via speech intelligibility and speech rate measures using the Test of Children's Speech Plus. Analyses included nonparametric bootstrapping, correlation analysis, and multiple regression. RESULTS Children with UCP exhibited more severe (higher) DDS scores (p = .0096, Part 1; p = .0132, Part 2) and reduced speech rate than TDC (p = .0120). Furthermore, in children with UCP, total DDS scores were moderately negatively correlated with speech intelligibility (words: r = -.6162, p = .0086; sentences: r = -.60792, p = .0096). Expressive language scores were the only significant predictor of feeding and swallowing performance, and receptive language scores were the only significant predictor of motor speech skills. CONCLUSIONS Swallowing and motor speech skills can be affected in school-age children with UCP, with wide variability of performance also noted. Preliminary cross-system interactions between swallowing, speech, and language are observed and might support the complex relationships between these domains. Further understanding these relationships in this population could have prognostic and/or therapeutic value and warrants further study.
Collapse
Affiliation(s)
- Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Samantha S. Mitchell
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | | | - Barbara Brown
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Bruce Α. Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Wendy Burdo-Hartman
- Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus
| | - Jennifer P. Lundine
- Nationwide Children's Hospital, Columbus, OH
- Department of Speech and Hearing Sciences, The Ohio State University, Columbus
| | - Meghan Darling-White
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Lisa Goffman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson
| |
Collapse
|
6
|
Rodby-Bousquet E, Agustsson A. Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing. Front Neurol 2021; 12:758706. [PMID: 34938261 PMCID: PMC8685523 DOI: 10.3389/fneur.2021.758706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions. Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing. Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting. Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.
Collapse
Affiliation(s)
- Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Atli Agustsson
- Research Centre of Movement Science, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| |
Collapse
|