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Lage CR, Wright S, Monteiro RGDS, Aragão L, Boshoff K. Collaborative practice with parents in occupational therapy for children: A scoping review. Aust Occup Ther J 2024. [PMID: 38923569 DOI: 10.1111/1440-1630.12974] [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: 09/19/2023] [Revised: 02/20/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION In childhood intervention, parent-therapist collaboration is central to the family-centred approach. Despite long-standing discussion in occupational therapy literature, the field faces challenges, including inconsistent terminology and difficulties in translating theory into practice. This paper represents the first part of a comprehensive scoping review study aimed at developing foundational concepts for collaborative practices with parents in occupational therapy for children. Therefore, this paper focusses on mapping existing practices, types, and approaches articulated in the literature. METHODS We searched English-language sources published worldwide from 1998 to 2022 discussing collaborative practices with parents in occupational therapy for children aged 0-10 with any diagnosis, including multidisciplinary practices. Seven databases were searched. Data from peer-reviewed indexed literature, theses and dissertations, and book chapters were extracted and analysed through basic numerical and descriptive analyses before being synthesised into similar categories. The Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic reviews and Meta-Analysis-extension for Scoping Reviews were used. RESULTS The scoping review yielded 299 papers. Parent-therapist collaboration was prominent in clinics, family homes, schools, and hospitals, particularly during therapy implementation, goal setting, and planning. Most reported practice types included 'interventions with parent engagement', 'parent-directed interventions', and 'parent education'. 'Family-centred', 'occupational-focussed', and 'client-therapist collaborative' approaches were frequently mentioned. There were inconsistencies in the terms used to describe collaborative practice characteristics. CONCLUSION Over the past 24 years, the collaborative practice literature has expanded and evolved, with parent-therapist collaboration observed across various occupational therapy settings. Inconsistencies in this collaboration across different therapeutic stages were revealed, which could impact intervention success and sustainability. Further research is needed to explore parent-therapist collaboration mechanisms within and across stages. This scoping review also underscores the need for a common framework to guide practice and research. PLAIN LANGUAGE SUMMARY This literature review explores how occupational therapists and parents work together in childhood intervention. Collaboration is essential for understanding and meeting children's needs within their family and community settings. However, occupational therapists and parents face challenges in applying family-centred practices and using a common language to bridge theory with practice. To address these challenges, we examined 299 papers published between 1998 and 2022 to understand how collaborative practices with parents have been described in the literature. Our review revealed that therapists and parents collaborate across various settings, such as clinics, schools, homes, and hospitals, mainly during therapy sessions, goal setting, and planning interventions. Collaborative practices take different forms. For instance, therapists often encourage parents to actively engage and take the lead in therapy, requiring therapists to recognise and respect parents' priorities and learning preferences. They often develop strategies together to support the child within family routines. While we found several studies on therapist-parent collaboration, the review outlined inconsistencies in how this practice was described and applied, which could affect its success. Therefore, more research is needed to understand the best ways in which collaboration can occur at each stage of therapy. The need for a core guideline for collaborative practice with parents in occupational therapy was also observed. While therapist-parent collaboration is used in occupational therapy for children, there is a clear need to minimise inconsistencies and gaps found in the literature, as well as to ensure a common language to promote intervention quality and success.
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Affiliation(s)
- Carla R Lage
- Allied Health and Human Performance, Occupational Therapy Program, University of South Australia, Adelaide, South Australia, Australia
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shelley Wright
- Allied Health and Human Performance, Occupational Therapy Program, University of South Australia, Adelaide, South Australia, Australia
| | - Rafaelle G de S Monteiro
- Department of Applied Social Sciences, Technological University of the Shannon: Midlands Midwest, Limerick, Ireland
| | - Luisa Aragão
- Department of Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kobie Boshoff
- Allied Health and Human Performance, Occupational Therapy Program, University of South Australia, Adelaide, South Australia, Australia
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), Adelaide, South Australia, Australia
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Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Intervenções para promover função física de crianças e jovens com paralisia cerebral: diretriz internacional de prática clínica. Dev Med Child Neurol 2022; 64:e15-e29. [PMID: 35729722 DOI: 10.1111/dmcn.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ResumoOBJETIVOFornecer recomendações de intervenções para promoção da função física de crianças e jovens com paralisia cerebral.MÉTODOUm painel de especialistas priorizou perguntas e desfechos importantes para o paciente. Usando o Grading of Recommendations Assessment, Development and Evaluation (GRADE), o painel avaliou a certeza das evidências e fez recomendações, com consultoria de especialistas internacionais e consumidores.RESULTADOSA diretriz compreende 13 recomendações (informadas por três revisões sistemáticas, 30 estudos randomizados e cinco estudos pré‐pós). Para alcance de objetivos funcionais, recomenda‐se que a intervenção inclua objetivos escolhidos pelo cliente, prática completa da tarefa em ambientes da vida real, suporte para empoderar as famílias e uma abordagem em equipe. Idade, habilidade e preferências da criança/família precisam ser consideradas. Para melhora da habilidade da marcha, recomenda‐se marcha no solo, que pode ser complementada com treinamento em esteira. Várias abordagens podem facilitar os objetivos relacionados ao uso das mãos: terapia bimanual, terapia de contensão induzida, treino direcionado a objetivos e abordagens cognitivas. Para auto‐cuidado, prática da tarefa completa, combinada com recursos assistivos podem aumentar a independência e reduzir a sobrecarga do cuidador. A participação em objetivos de lazer pode combinar prática da tarefa completa com estratégias direcionadas para barreiras ambientais, pessoais e sociais.INTERPRETAÇÃOIntervenção para promoção da função de crianças e jovens com paralisia cerebral precisa incluir objetivos escolhidos pelo cliente e a prática da tarefa completa dos objetivos. Os clínicos devem considerar as preferências da criança/família, idade e habilidade ao selecionarem intervenções específicas.
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Affiliation(s)
- Michelle Jackman
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
- John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Leanne Sakzewski
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roslyn N Boyd
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
| | - Sue E Brennan
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Rachel A M Toovey
- Physiotherapy Department, University of Melbourne, Melbourne, VIC, Australia
| | - Sue Greaves
- Occupational Therapy Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Brisbane, QLD, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Dev Med Child Neurol 2022; 64:536-549. [PMID: 34549424 DOI: 10.1111/dmcn.15055] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
AIM To provide recommendations for interventions to improve physical function for children and young people with cerebral palsy. METHOD An expert panel prioritized questions and patient-important outcomes. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, the panel assessed the certainty of evidence and made recommendations, with international expert and consumer consultation. RESULTS The guideline comprises 13 recommendations (informed by three systematic reviews, 30 randomized trials, and five before-after studies). To achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences need to be considered. To improve walking ability, overground walking is recommended and can be supplemented with treadmill training. Various approaches can facilitate hand use goals: bimanual therapy, constraint-induced movement therapy, goal-directed training, and cognitive approaches. For self-care, whole-task practice combined with assistive devices can increase independence and reduce caregiver burden. Participation in leisure goals can combine whole-task practice with strategies to address environmental, personal, and social barriers. INTERPRETATION Intervention to improve function for children and young people with cerebral palsy needs to include client-chosen goals and whole-task practice of goals. Clinicians should consider child/family preferences, age, and ability when selecting specific interventions.
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Affiliation(s)
- Michelle Jackman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sue E Brennan
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rachel A M Toovey
- Physiotherapy Department, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Greaves
- Occupational Therapy Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Brisbane, Queensland, Australia
| | - Iona Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Iorio-Morin C, Yap R, Dudley RWR, Poulin C, Cantin MA, Benaroch TE, Farmer JP. Selective Dorsal Root Rhizotomy for Spastic Cerebral Palsy: A Longitudinal Case-Control Analysis of Functional Outcome. Neurosurgery 2019; 87:186-192. [DOI: 10.1093/neuros/nyz422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDThe benefit of selective dorsal rhizotomies (SDR) on motor function relative to the cerebral palsy (CP) natural history remains unknown.OBJECTIVETo determine the functional benefit of SDR over the longitudinal CP natural history.METHODSRetrospective, single-center, case-control study of patients post-SDR after 1990. Inclusion criteria were the following: diagnosis of spastic CP, at least 1 preoperative and 1 postoperative Gross Motor Function Measure (GMFM-88), at least 1 yr of postoperative follow-up. GMFM-88 assessments were performed at 1, 2, 3, 5, 10, and 15 yr postoperatively and converted to GMFM-66. Cases were stratified by preoperative Gross Motor Function Classification System (GMFCS) and matched against their expected natural history using published reference centiles. After age 12, our cohort and matched controls were also fitted to published nonlinear mixed models of GMFM-66 evolution over time.RESULTSAnalysis included 190 patients. Median follow-up, 5.3 yr (range: 1-16.9), median age at surgery, 4.6 yr, and 81.6% of patients grouped as GMFCS II or III pre-op. SDR patients performed statistically significantly better than their expected natural history (P < .0005). At 21 yr old, a modeled benefit of 8.435 was observed for GMFCS I (P = .0051), 0.05 for GMFCS II (P = .9647), 6.31 for GMFCS III (P < .0001), and 1.191 for GMFCS IV patients (P = .0207).CONCLUSIONThese results support the use of SDR in carefully selected spastic CP children.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Canada
| | - Rita Yap
- Physical Therapy, Shriners Hospital for Children, Montreal, Canada
| | - Roy W R Dudley
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Chantal Poulin
- Division of Neurology, Montreal Children's Hospital, Montreal, Canada
| | - Marie-Andrée Cantin
- Division of Orthopedic Surgery, Department of Pediatric Surgery, CHU Sainte-Justine and Shriners Hospital for Children, Université de Montréal, Montreal, Canada
| | - Thierry E Benaroch
- Division of Orthopedic Surgery, Department of Pediatric Surgery, Montreal Children's Hospital and Shriners Hospital for Children, McGill University, Montreal, Canada
| | - Jean-Pierre Farmer
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
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Hielkema T, Boxum AG, Hamer EG, La Bastide-Van Gemert S, Dirks T, Reinders-Messelink HA, Maathuis CGB, Verheijden J, Geertzen JHB, Hadders-Algra M. LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: family outcome and infant's functional outcome. Disabil Rehabil 2019; 42:3762-3770. [PMID: 31141410 DOI: 10.1080/09638288.2019.1610509] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy.Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models.Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching."Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services.Implications for rehabilitationOne year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy.Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life.Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy.
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Affiliation(s)
- Tjitske Hielkema
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, The Netherlands
| | - Anke G Boxum
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Elisa G Hamer
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, The Netherlands.,Radboud University Medical Center Nijmegen, Department of Neurology, Nijmegen, The Netherlands
| | - Sacha La Bastide-Van Gemert
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Tineke Dirks
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, The Netherlands.,Rehabilitation Center "Revalidatie Friesland", Beetsterzwaag, The Netherlands
| | - Carel G B Maathuis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, The Netherlands
| | - Johannes Verheijden
- BOSK, Association of persons with a physical disability, Utrecht, The Netherlands
| | - Jan H B Geertzen
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, The Netherlands
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Division of Developmental Neurology, Groningen, The Netherlands
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Lee DJ, Yang W, Propst EJ, Rosenblatt SD, Hseu A, Wolter NE. Tracheo-innominate fistula in children: A systematic review of literature. Laryngoscope 2019; 130:217-224. [PMID: 30632162 DOI: 10.1002/lary.27765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Tracheo-innominate fistula (TIF) is a rare but fatal complication of tracheotomy. To date, there is a paucity of literature regarding pediatric TIFs. The objectives of this study were to conduct a systematic review of literature on pediatric TIF following tracheotomy and describe three demonstrative cases from our institutional experience. METHODS We conducted a systematic review using MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL. All studies with pediatric patients (under 18 years of age) who developed TIF following tracheotomy were included. RESULTS Fifty-four publications met inclusion criteria, reporting on 77 cases. The most common indication for tracheotomy was prolonged intubation and the need for ventilatory support (38.6%), with neurological comorbidities being the most common indication (72.7%). The mean time to TIF was 395.7 days (95% confidence interval, 225.9-565.5). Fifty-four patients (70.1%) presented with massive hemorrhage, whereas 18 patients (23.3%) presented with a sentinel bleeding event. The most common diagnostic interventions were computed tomography scan with or without contrast and bronchoscopy (55.8%). A substantial number of patients did not have any investigations (41.6%). Surgical management occurred in 70.1% of patients. Mortality was 38.6% in reported cases with variable follow-up periods. CONCLUSION TIF may occur in long-term tracheostomy-dependent children, contrary to the conventionally described 3-week postoperative period. The mortality may not be as high as previously reported with timely intervention. Our results are limited by inherent risks of bias. Further research including well-designed cohort studies are needed to guide an evidence-based approach to TIF. LEVEL OF EVIDENCE NA Laryngoscope, 130:217-224, 2020.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven D Rosenblatt
- Department of Otolaryngology-Head & Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Boston, Massachusetts, U.S.A
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Hielkema T, Toonen RF, Hooijsma SJ, Dirks T, Reinders-Messelink HA, Maathuis CGB, Geertzen JHB, Hadders-Algra M. Changes in the Content of Pediatric Physical Therapy for Infants: A Quantitative, Observational Study. Phys Occup Ther Pediatr 2018; 38:457-488. [PMID: 29265913 DOI: 10.1080/01942638.2017.1405863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS The aim of our observational longitudinal study is to evaluate changes over time in standard pediatric physical therapy (PPT) for infants at risk of neurodevelopmental disorders. METHODS Treatment sessions in two time periods (2003-2005 [n = 22] and 2008-2014 [n = 16]) were video recorded and analyzed quantitatively in five categories: neuromotor actions, educational actions, communication, position, and situation of treatment session. Differences in percentages of time spent on therapeutic actions between periods were tested with Mann-Whitney U and Hodges Lehmann's tests. RESULTS No significant changes appeared in the main categories of neuromotor actions. Time spent on not-specified educational actions toward caregivers (median from 99% to 81%, p = .042) and not-specified communication (median from 72% to 52%, p = .002) decreased. Consequently, time spent on specific educational actions (caregiver training and coaching; median from 1% to 19%, p = .042) and specific communication (information exchange, instruct, provide feedback; median from 21% to 38%, p = .007) increased. Infant position changed only minimally: time spent on transitions-that is, change of position-decreased slightly over time (median from 7% to 6%, p = .042). Situation of treatment session did not change significantly over time. CONCLUSIONS Neuromotor actions in PPT remained largely stable over time. Specific educational actions and communication increased, indicating larger family involvement during treatment sessions.
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Affiliation(s)
- Tjitske Hielkema
- a University of Groningen, University Medical Center Groningen , Department of Paediatrics, Division of Developmental Neurology , Hanzeplein 1, Groningen , the Netherlands.,b University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine Hanzeplein 1 , Groningen , the Netherlands
| | - Rivka F Toonen
- a University of Groningen, University Medical Center Groningen , Department of Paediatrics, Division of Developmental Neurology , Hanzeplein 1, Groningen , the Netherlands.,b University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine Hanzeplein 1 , Groningen , the Netherlands
| | - Siebrigje J Hooijsma
- a University of Groningen, University Medical Center Groningen , Department of Paediatrics, Division of Developmental Neurology , Hanzeplein 1, Groningen , the Netherlands
| | - Tineke Dirks
- a University of Groningen, University Medical Center Groningen , Department of Paediatrics, Division of Developmental Neurology , Hanzeplein 1, Groningen , the Netherlands
| | - Heleen A Reinders-Messelink
- b University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine Hanzeplein 1 , Groningen , the Netherlands.,c Rehabilitation Center "Revalidatie Friesland," Hoofdstraat 3 , Beetsterzwaag , The Netherlands
| | - Carel G B Maathuis
- b University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine Hanzeplein 1 , Groningen , the Netherlands
| | - Jan H B Geertzen
- b University of Groningen, University Medical Center Groningen, Center for Rehabilitation , Department of Rehabilitation Medicine Hanzeplein 1 , Groningen , the Netherlands
| | - Mijna Hadders-Algra
- a University of Groningen, University Medical Center Groningen , Department of Paediatrics, Division of Developmental Neurology , Hanzeplein 1, Groningen , the Netherlands
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McDonald R, Sawatzky B, Franck L. A comparison of flat and ramped, contoured cushions as adaptive seating interventions for children with neurological disorders. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2014.981189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Beveridge B, Feltracco D, Struyf J, Strauss E, Dang S, Phelan S, Wright FV, Gibson BE. "You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy. Phys Occup Ther Pediatr 2015; 35:327-41. [PMID: 25529412 DOI: 10.3109/01942638.2014.990547] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the "newest thing" in treatment. The aim of this qualitative study was to explore parents' values about walking in relation to their experiences with robotic gait training for their children. METHODS Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. RESULTS Parents valued walking, especially "correct" walking, as a key component of their children's present and future well-being. They continually sought the "next best thing" in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. CONCLUSIONS The results can help inform rehabilitation therapists' knowledge of parents' values and perspectives, and guide effective collaborations toward meeting the therapeutic needs of children with CP.
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Affiliation(s)
- Briony Beveridge
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Deanna Feltracco
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Jillian Struyf
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Emily Strauss
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Saniya Dang
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada
| | - Shanon Phelan
- b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,c 3 Department of Occupational Therapy, University of Alberta , Edmonton, Canada
| | - F Virginia Wright
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada.,b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Barbara E Gibson
- a 1 Department of Physical Therapy, University of Toronto , Toronto, Canada.,b 2 Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
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Gajewska E, Barańska E, Sobieska M, Moczko J. Motor performance in the third, not the second month, predicts further motor development. J Mot Behav 2014; 47:246-55. [PMID: 25415833 DOI: 10.1080/00222895.2014.974495] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim was to verify if motor performance at second or third month of life better predicts further development. The global motor development was assessed by a neurologist and by a physiotherapist in 111 children at 2, 3, 6, and 9 months. At 2 and 3 months a physiotherapist also performed the assessment of qualitative elements. The physiotherapeutic assessment in the third month showed higher compatibility with the neurological assessment. Proper motor performance at third month could ensure the level of at least 7 months in the ninth month of life. Qualitative score above 7 of 15 points in the third month ensured proper development in ninth month. Third month of life is a better predictor of further motor development.
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Affiliation(s)
- Ewa Gajewska
- a Department of Rheumatology and Rehabilitation , Poznań University of Medical Sciences , Poland
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Bourke-Taylor H, Cotter C, Stephan R. Complementary, Alternative, and Mainstream Service use Among Families with Young Children with Multiple Disabilities: Family Costs to Access Choices. Phys Occup Ther Pediatr 2014; 35:311-325. [PMID: 25365470 DOI: 10.3109/01942638.2014.975312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in families reporting forgoing clothing items, family entertainment, recreation/hobbies for parents (55%); family holidays (59%); time for parents alone (66%); and health services for parents (38%). Conclusions: Families of young children with multiple disabilities select a wide range of services for their child, with consequential out of pocket expenses. Early intervention professionals can be an important resource for families as they evaluate their choices and select interventions for their child.
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Affiliation(s)
- Helen Bourke-Taylor
- 1Faculty of Health Sciences, School of Allied Health, Australian Catholic University, Fitzroy, Australia
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Bourke-Taylor H, Cotter C, Stephan R. Young children with cerebral palsy: families self-reported equipment needs and out-of-pocket expenditure. Child Care Health Dev 2014; 40:654-62. [PMID: 23952344 DOI: 10.1111/cch.12098] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Costs to families raising a child with cerebral palsy and complex needs are direct and indirect. This study investigated the self-reported real-life costs, equipment needs, and associated characteristics of children who had the highest equipment and care needs. METHOD The purposive sample (n = 29) were families with a child with cerebral palsy: gross motor function levels 5 (n = 20), level 4 (n = 5), level 3 (n = 4); complex communication needs (n = 21); medical needs (n = 14); hearing impairment (n = 5) and visual impairment (n = 9). Participants completed a specifically designed survey that included the Assistance to Participate Scale. Equipment and technology purchases were recorded in the areas of positioning, mobility, transport, home modifications, communication, splinting and orthoses, self-care, technology, communication devices, medical, adapted toys/leisure items and privately hired babysitters/carers. Descriptive and inferential statistics were used to analyse the data. RESULTS Families had purchased up to 25 items within the areas described. The highest median number of items were recorded for positioning (15 items), mobility devices (9 items) and adapted toys/leisure items (9 items). Median costs were highest for home modifications (AUD$23000), transport (AUD$15000), splints and orthoses (AUD$3145), paid carers (AUD$3080), equipment for toileting/dressing/bathing (AUD$2900) and technical/medical items ($2380). Children who needed more parental assistance to participate in play and recreation also required significantly more equipment overall for positioning, communication, self-care and toys/leisure. CONCLUSIONS The equipment needs of young children with complex disability are extensive and out-of-pocket expenses and parental time to support participation in play/recreation excessive. Substantial financial support to offset costs are crucial to better support families in this life situation.
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Affiliation(s)
- H Bourke-Taylor
- Occupational Therapy Department, Faculty of Medicine, Nursing and Health Sciences, School of Primary Health Care, Monash University, Frankston, Vic., Australia
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Walsh SF, Scharf MG. Effects of a recreational ice skating program on the functional mobility of a child with cerebral palsy. Physiother Theory Pract 2013; 30:189-95. [DOI: 10.3109/09593985.2013.863414] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Richards CL, Malouin F. Cerebral palsy: definition, assessment and rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 111:183-195. [PMID: 23622163 DOI: 10.1016/b978-0-444-52891-9.00018-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the last 25 years the definition and classification of cerebral palsy (CP) have evolved, as well as the approach to rehabilitation. CP is a disorder of the development of movement and posture, causing activity limitations attributed to nonprogressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. Motor control during reaching, grasping, and walking are disturbed by spasticity, dyskinesia, hyperreflexia, excessive coactivation of antagonist muscles, retained developmental reactions, and secondary musculoskeletal malformations, together with paresis and defective programing. Weakness and hypoextensibility of the muscles are due not only to inadequate recruitment of motor units, but also to changes in mechanical stresses and hormonal factors. Two methods, the General Movements Assessment and the Test of Infant Motor Performance, now permit the early detection of CP, while the development of valid and reliable outcome measures, particularly the Gross Motor Function Measure (GMFM), have made it possible to evaluate change over time and the effects of clinical interventions. The GMFM has further led to the development of predictive curves of motor function while the Gross Motor Classification System and the Manual Ability Classification System provide standardized means to classify the severity of the movement disability. With the emergence of the task-oriented approach, the focus of therapy in rehabilitation has shifted from eliminating deficits to enhancing function across all performance domains by emphasizing fitness, function, participation, and quality of life. There is growing evidence supporting selected interventions and interest for the therapy and social integration of adults with CP.
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Affiliation(s)
- Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada
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Scheeren EM, Mascarenhas LPG, Chiarello CR, Costin ACMS, Oliveira L, Neves EB. Description of the Pediasuit ProtocolTM. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: PediaSuit ProtocolTM is an intensive therapy with a holistic approach to the treatment of individuals with neurological disorders like cerebral palsy (CP), developmental delays, traumatic brain injuries, autism and other conditions which affect a child's motor and/or cognitive functions. OBJECTIVE: The aim of the present work is to describe the PediaSuit ProtocolTM. METHODS: The authors team remained two months observing the care provided in a clinic with physical therapists trained by the PediaSuit ProtocolTM team (USA). RESULTS: The PediaSuitTM is a therapeutic protocol which uses a suit combined with intensive physical therapy and consists of up to four hours of therapy a day, five days a week, during three or four weeks. The PediaSuit ProtocolTM is customized to fit the needs of each child, with specific functional goals, and usually involves an intensive rehabilitation program. It combines the best elements of various techniques and methods, and has a sound rationale based on exercise physiology. CONCLUSION: This protocol anticipates results obtained only with long periods of conventional physical therapy.
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Lukić S, Ćojbašić Ž, Jović N, Popović M, Bjelaković B, Dimitrijević L, Bjelaković L. Artificial neural networks based prediction of cerebral palsy in infants with central coordination disturbance. Early Hum Dev 2012; 88:547-53. [PMID: 22281057 DOI: 10.1016/j.earlhumdev.2012.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/01/2011] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a previous study we demonstrated that heart variability parameters (HRV) could be helpful clinically as well as a prognostic tool in infants with central coordination disturbance (CCD). In recent years, outcome predictions using artificial neural networks (ANN) have been developed in many areas of health care research, but there are no published studies considered ANN models for prediction of cerebral palsy (CP) development. OBJECTIVE To compare the results of an ANN analysis with results of regression analysis, using the same data set and the same clinical and HRV parameters. METHODS The study included 35 infants with CCD and 37 healthy age and sex-matched controls. Time-domain HRV indices were analyzed from 24h electrocardiography recordings. Clinical parameters and selected time domain HRV parameters are used to predict CP by logistic regression, and then an ANN analysis was applied to the same data set. Input variables were age, gender, postural responses, heart rate parameters (minimum, maximum and average), and time domain parameters of HRV (SDNN, SDANN and RMSSD). For each of one the pairs of ANN and clinical predictors, the area under the receiver operating characteristic (ROC) curves with test accuracy parameters were calculated and compared. RESULTS In the observed dataset, ANN model overall correctly classified all infants, compared with 86.11% correct classification for the logistic regression model, and compared with 67.65% and 77.14% for SDANN and SDNN respectively. CONCLUSIONS ANN model, based on clinical and HRV data can predict development of CP in patients with CCD with accuracy greater than 90%. Our results strongly indicate that a well-validated ANN may have a role in the clinical prediction of CP in infants with CCD.
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Affiliation(s)
- Stevo Lukić
- Clinic of Neurology, Clinical centre Niš, Serbia.
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Tantilipikorn P, Watter P, Prasertsukdee S. Identifying assessment measures and interventions reported for Thai children with cerebral palsy using the ICF-CY framework. Disabil Rehabil 2011; 34:1178-85. [DOI: 10.3109/09638288.2011.637603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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Martin L, Baker R, Harvey A. A systematic review of common physiotherapy interventions in school-aged children with cerebral palsy. Phys Occup Ther Pediatr 2010; 30:294-312. [PMID: 20735200 DOI: 10.3109/01942638.2010.500581] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This systematic review focused on the common conventional physiotherapy interventions used with children with cerebral palsy (CP), aged 4 to 18 years, and critically appraised the recent evidence of each of these interventions using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The search strategy yielded 34 articles after inclusion and exclusion criteria were applied. The investigated physiotherapy interventions included strength and functional training, weight-supported treadmill training (WBSTT), and neurodevelopmental treatment (NDT). A category of treatment dosage was also included. Strength training was the most studied intervention with significant improvements found in the strength of selected muscle groups using dynamometry, with fewer studies showing significant improvement in function. Functional training showed improvements in gross motor function, endurance, and temperospatial measures, such as gait speed and stride length. Nonsignificant trends of improvement on the Gross Motor Function Measure (GMFM) and gait velocity were found for WBSTT by a few studies with low levels of evidence (case series). Of three studies that evaluated NDT, one high-level evidence study, i.e., randomized controlled trial (RCT) found significant improvements on the GMFM. All studies reviewing treatment dosage had high levels of evidence (RCTs), yet found no significant differences for different intensities of treatment. These results indicate that the levels of evidence for physiotherapy interventions, particularly strengthening and to a lesser extent functional training, in school-aged children with CP has improved; however, further high-level evidence is needed for other interventions.
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Affiliation(s)
- Liz Martin
- Yooralla, Belmore School, Balwyn, Australia.
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Abstract
BACKGROUND Understanding family priorities for children and youth with cerebral palsy is essential for family-centered service. OBJECTIVE The purposes of this study were: (1) to identify family priorities for activity and participation in children and youth with cerebral palsy and (2) to determine differences based on age and Gross Motor Functional Classification System (GMFCS) level. DESIGN Five hundred eighty-five children and youth with cerebral palsy and their caregivers participated at regional children's hospitals. The children and youth were 2 to 21 years of age; 56% were male, and 44% were female. Their caregivers, predominantly mothers (80%), had a mean age of 40.3 years (SD=9.3). The Canadian Occupational Performance Measure was administered to caregivers to identify their priorities for their children. The priorities were coded into 3 categories (daily activities, productivity, and leisure) and 13 subcategories. The GMFCS levels were determined by assessors who met the criterion for reliability. Friedman and Kruskal-Wallis one-way analyses of variance were used to examine differences in priorities. RESULTS Parents of children in all age groups and GMFCS levels II to V identified more priorities for daily activities. Parents of school-aged children and youth had more priorities for productivity than parents of younger children. For parents of children in all age groups and motor function levels, self-care was the most frequent priority subcategory. Sixty-one percent of parents identified at least one priority related to mobility. LIMITATIONS The study did not include qualitative analysis of priorities of parents. CONCLUSIONS Parents' priorities for their children and youth with cerebral palsy differed depending on age and gross motor function level; however, the most frequent priority for all age groups was daily activities. Interviews with families are recommended for identifying outcomes for activity and participation and developing an intervention plan.
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Keren-Capelovitch T, Jarus T, Fattal-Valevski A. Upper extremity function and occupational performance in children with spastic cerebral palsy following lower extremity botulinum toxin injections. J Child Neurol 2010; 25:694-700. [PMID: 20508235 DOI: 10.1177/0883073809344621] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We studied the effect of botulinum toxin A injections to the lower extremities of spastic cerebral palsy children on upper limb body function and occupational performance. A total of 16 children with spastic cerebral palsy, aged 2 to 8 years, Gross Motor Function Classification System levels I-IV, referred to a child neurology outpatient clinic for botulinum toxin A injections to the lower limbs, underwent 4 assessments: 1 month prior to injection, immediate pre injection, and at 1 and 5 to 6 months post injection. Three tools were used to test everyday function (Canadian Occupational Performance Measure and the Pediatric Evaluation of Disability Inventory) and upper extremity body function (Quality of Upper Extremity Skills Test). Significant improvement was documented between the immediate preinjection and the 2 postinjection assessments, indicating that improvement lasted for at least 6 months. Botulinum toxin A injections to the lower extremities in children with cerebral palsy improve upper limb body function and occupational performance.
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Affiliation(s)
- Tal Keren-Capelovitch
- Department of Occupational Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Palisano RJ, Almarsi N, Chiarello LA, Orlin MN, Bagley A, Maggs J. Family needs of parents of children and youth with cerebral palsy. Child Care Health Dev 2010; 36:85-92. [PMID: 19961501 DOI: 10.1111/j.1365-2214.2009.01030.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the needs of families of children and youth with cerebral palsy (CP) is important for family-centred services. The aims of this study were to identify: (1) differences in the number and types of family needs expressed by parents based on the age and gross motor function level of their children with CP; (2) the most frequent family needs; and (3) needs that differ on gross motor function level. METHODS A total of 501 parents (77.6% mothers) of children and youth with CP completed a modified version of a Family Needs Survey and a demographic questionnaire. Children's gross motor function level was classified using the Gross Motor Function Classification System. RESULTS Total number of family needs differed based on gross motor function level (P < 0.001) but not age. Parents of children/youth who use wheeled mobility expressed the highest number of family needs, while parents of children/youth who walk without restrictions expressed the fewest needs. Family needs for Information (P= 0.001), Support (P= 0.001), Community Services (P < 0.001) and Finances (P < 0.001) differed based on children's gross motor function level. Over 50% of parents expressed family needs for information on current and future services, planning for the future, help in locating community activities and more personal time. Parents of children and youth who use wheeled mobility were more likely to express the need for help in paying for home modifications, equipment, services and locating sitters, respite care providers and community activities. CONCLUSIONS The gross motor function of children/youth with CP has implications for collaboration with families to identify needs and co-ordinate services. Health professionals have a role to assist families with information needs and locating community services and leisure activities. Family needs for future planning suggest that health professionals should assist families to prepare for key periods in the lives of their children with CP.
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Affiliation(s)
- R J Palisano
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 245 N. Broad Street, Philadelphia, PA 19102-1192, USA.
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Wiart L, Ray L, Darrah J, Magill-Evans J. Parents' perspectives on occupational therapy and physical therapy goals for children with cerebral palsy. Disabil Rehabil 2009; 32:248-58. [DOI: 10.3109/09638280903095890] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cusick A, Convey M, Novak I, McIntyre S. Employer-sponsored occupational therapy professional development in a multicampus facility: A quality project. Aust Occup Ther J 2009; 56:229-38. [DOI: 10.1111/j.1440-1630.2008.00745.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brianeze ACGES, Cunha AB, Peviani SM, Miranda VCR, Tognetti VBL, Rocha NACF, Tudella E. Efeito de um programa de fisioterapia funcional em crianças com paralisia cerebral associado a orientações aos cuidadores: estudo preliminar. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000100008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi verificar o efeito de um programa de fisioterapia funcional para crianças com paralisia cerebral, associado a orientações aos pais e/ou cuidadores; e verificar a correlação entre as habilidades funcionais e a assistência do cuidador, utilizando o Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Participaram quatro crianças entre 24 e 43 meses de idade, hemiplégicas, espásticas e nível I no sistema de classificação da função motora ampla (GMFCS). Foram realizadas quatro avaliações - uma antes do início do programa, as demais aos 30, 60 e 90 dias após a primeira -, empregando-se as partes I (Habilidades funcionais) e II (Assistência do cuidador) do PEDI. As crianças foram submetidas a sessões de uma hora de fisioterapia funcional três vezes por semana, durante três meses: duas vezes a sessão era de fisioterapia com base no conceito neuroevolutivo Bobath e uma vez, treino de atividades da vida diária. Também foram dadas orientações por escrito aos pais e/ou cuidadores quanto à assistência à criança, incentivando-os a praticá-la em casa. A análise dos resultados mostrou que, na última avaliação, as crianças obtiveram escores significativamente maiores que na primeira. Foi verificada correlação altamente significativa (r=1,0; p=0,083) entre as partes I e II. O programa de fisioterapia funcional associado às orientações aos pais e/ou cuidadores foi efetivo em melhorar o desempenho funcional de crianças nível I com hemiplegia espástica.
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Palisano RJ, Shimmell LJ, Stewart D, Lawless JJ, Rosenbaum PL, Russell DJ. Mobility experiences of adolescents with cerebral palsy. Phys Occup Ther Pediatr 2009; 29:133-53. [PMID: 19401928 DOI: 10.1080/01942630902784746] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to describe how youth with cerebral palsy experience mobility in their daily lives using a phenomenological approach. The participants were 10 youth with cerebral palsy, 17 to 20 years of age, selected using purposeful sampling with maximum variation strategies. A total of 14 interviews were completed. Transcripts were analyzed for key concepts and themes. Credibility was established through triangulation of researchers and member checking. Participants viewed mobility as important for self-sufficiency. Youth who walked and also used wheeled mobility spoke of making choices. Safety and efficiency were important considerations when making choices. Some participants had mobility preferences at home that may not be safe, practical, or socially appropriate at school or in the community. Youth spoke of constantly adapting to situations that often reflected a lack of control over the environment. Youth indicated the need for constantly planning ahead to go places and do things. Most participants were dependent on others for transportation and expressed dissatisfaction with public transportation. Safe and efficient mobility to enable participation in daily activities appears to be the primary concern of youth with cerebral palsy.
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Affiliation(s)
- Robert J Palisano
- Department of Physical Therapy & Rehabilitation Sciences, Drexel University, Philadelphia, PA 19102-1192, USA.
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Abstract
PURPOSE To compare 3 different assessment approaches at term to infants born preterm to predict motor and functional outcomes at 12 months adjusted age. METHODS Infants (n = 100) born at less than 32 weeks postconceptional age were assessed at term using the General Movements Assessment, Einstein Neonatal Neurobehavioral Assessment Scales, Test of Infant Motor Performance, and at 12 months adjusted age using the Alberta Infant Motor Scales, Peabody Developmental Motor Scales-2, Vineland Adaptive Behavior Scales-Daily Living Skills, and Battelle Developmental Inventory. RESULTS The General Movements Assessment (r2 = 0.04; p = 0.05) and the Test of Infant Motor Performance (r2 = 0.05; p = 0.04) predicted outcomes on the Peabody Developmental Motor Scales-2. The Test of Infant Motor Performance predicted outcomes on the Alberta Infant Motor Scales (r2 = 0.05; p = 0.04) and Vineland Adaptive Behavior Scales-Daily Living Skills (odds ratio: 0.93). Delays in functional performance were found. CONCLUSIONS Neonatal tests at term explained a small but significant proportion of the variance in gross motor and daily living skills at 12 months adjusted age.
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Velders M, Legerlotz K, Falconer SJ, Stott NS, McMahon CD, Smith HK. Effect of botulinum toxin A-induced paralysis and exercise training on mechanosensing and signalling gene expression in juvenile rat gastrocnemius muscle. Exp Physiol 2008; 93:1273-83. [DOI: 10.1113/expphysiol.2008.043174] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Cerebral palsy is the most common chronic disability of childhood today. The concept of management rather than cure forms the basis of intervention. Therapy programs should be integrated with summer camps, home activities, and school, enabling the child and the family to live as close to normal as possible. Successful rehabilitation should prevent additional problems, minimize disability, and create a happy child.
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Nuysink J, van Haastert IC, Takken T, Helders PJM. Symptomatic asymmetry in the first six months of life: differential diagnosis. Eur J Pediatr 2008; 167:613-9. [PMID: 18317801 PMCID: PMC2292481 DOI: 10.1007/s00431-008-0686-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 01/27/2008] [Accepted: 01/29/2008] [Indexed: 12/01/2022]
Abstract
Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument.
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Affiliation(s)
- Jacqueline Nuysink
- Department of Pediatric Physical Therapy & Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center, KB 02.056.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
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Snider LM, Majnemer A, Mazer B, Campbell S, Bos AF. A comparison of the general movements assessment with traditional approaches to newborn and infant assessment: concurrent validity. Early Hum Dev 2008; 84:297-303. [PMID: 17766062 DOI: 10.1016/j.earlhumdev.2007.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 07/13/2007] [Accepted: 07/16/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Assessment of the quality of general movements (GMs) is an early clinical marker for prediction of cerebral palsy. AIMS To explore how the General Movements Assessment (GMsA) relates to traditional newborn and infant measures currently in use. STUDY DESIGN A prospective cohort design was used to examine concurrent validity of the GMsA in Neonatal Intensive Care (NICU) survivors (n=100) at three age points: preterm (34 weeks gestational age GA), term (38-40 weeks GA), and post term (12 weeks adjusted age [AA]) with traditional assessments (see below). Correlation analysis was used to determine the strength of the associations between tests at each age point. SUBJECTS Preterm infants born at <or=32 weeks gestational age and birth weight <1,500 g (n=108) were recruited sequentially from the NICU of a large teaching hospital and referral centre. Infants with diagnoses of metabolic disorders, cardiac, chromosomal, or congenital abnormalities were excluded. OUTCOME MEASURES Test of Infant Motor Performance (TIMP), Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS), Alberta Infant Motor Scales (AIMS). RESULTS A low-strength relationship (r=or<0.25) was found between the GMsA and the traditional tests which increased across age points (r=0.25-0.50). Relationships between the traditional tests over time was characterized by stronger associations (r=0.50-0.75). CONCLUSIONS Evidence of concurrent validity of the GMsA with traditional assessments was not found. These early findings support Prechtl's suggestion that GMs reflect a unique neurologic construct, different from traditional tests and reinforce the complementary perspective which the GMsA brings to neonatal assessment.
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Affiliation(s)
- Laurie M Snider
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada.
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Abstract
Classification of the quality and topographical pattern of motor impairment is used to describe cerebral palsy (CP). As an adjunct to a study characterizing the quality of life and participation of school-age children with C P, initial and follow-up classification of CP were compared. A cohort of 93 children (58 males, 35 females) were initially assessed at a mean age of 2 years 6 months (SD 2y 2mo) and re-assessed at 9 years 4 months (SD 2y 2mo) with a mean interval of 6 years 6 months (SD 2y 4mo) between assessments. Sixty children had Gross Motor Function Classification System levels I-III. All but one of the children were still classified has having CP at follow-up. Type of CP documented remained constant in 67 children (72%; 95% confidence interval 62-80). Clinical factors that were statistically significant (p<0.05) as possible predictors of CP subtype change were original classification of a non-spastic subtype or a non-spastic quadriparetic subtype. Change in CP subtype occurs in an appreciable minority of children with CP, which is likely to reflect a combination of intrinsic and extrinsic influences. Such change may challenge efforts to monitor the effects of interventions in this population.
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Affiliation(s)
- Michael I Shevell
- Neurology/Neurosurgery and Pediatrics, McGill University, Montreal, Quebec, Canada.
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Do therapists' goals and interventions for children with cerebral palsy reflect principles in contemporary literature? Pediatr Phys Ther 2008; 20:334-9. [PMID: 19011523 DOI: 10.1097/pep.0b013e31818a1d41] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore therapists' goal setting and intervention with children with cerebral palsy, and to examine their acceptance of children's use of compensatory movement strategies. METHODS Interviews were conducted with 23 occupational therapists and 31 physical therapists. Goals and assumptions of relationships between intervention approaches and expected outcomes were coded using the International Classification of Functioning, Disability, and Health (ICF). Therapists' acceptance of compensatory movement strategies was rated. RESULTS Thirty-three therapists identified goals representing the ICF activity component. Therapists working with younger children identified goals representing the ICF body function/structure component. Twenty-four therapists assumed that an intervention targeted at 1 ICF component would affect an outcome in a different component. Eleven therapists would not accept compensatory movement strategies. CONCLUSIONS Most therapists' goals are congruent with principles encouraging functional goals. The ICF matrix developed for this study may be useful for clinical evaluation and documentation of assumed relationships among interventions and outcomes.
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Abstract
PURPOSE To review research regarding mechanisms of muscle contracture in cerebral palsy (CP) and the effectiveness of stretching, and to discuss current physical therapy stretching practices. Community-based recreation opportunities that encourage flexibility and fitness are explored as alternatives to traditional therapy stretching approaches. SUMMARY OF KEY POINTS Mechanisms of muscle contracture in children with CP are unclear and clinical research evaluating the effects of stretching is inconclusive. Recent shifts in thinking about the management of children with CP suggest an increased emphasis on flexibility, fitness, and participation in activities that are meaningful to children and families. STATEMENT OF CONCLUSIONS Additional research is needed to explore the structural changes that occur in the shortened muscles of children with CP and the effects of stretching practices used in pediatric physical therapy. RECOMMENDATIONS FOR CLINICAL PRACTICE Physical therapists can consider innovative alternatives that integrate flexibility and fitness goals with community-based recreation programs.
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Sakzewski L, Boyd R, Ziviani J. Clinimetric properties of participation measures for 5- to 13-year-old children with cerebral palsy: a systematic review. Dev Med Child Neurol 2007; 49:232-40. [PMID: 17355482 DOI: 10.1111/j.1469-8749.2007.00232.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study systematically reviewed the validity, reliability, sensitivity to change, and clinical utility of measurements of participation for children with cerebral palsy. Sixteen measures were identified and seven met the inclusion criteria of having 30% content measuring participation, for use with children aged 5 to 13 years with physical disability, and were condition specific. The Children's Assessment of Participation and Enjoyment (CAPE) assessed participation in leisure and recreation, while the School Function Assessment (SFA) and School Outcome Measure addressed participation in the school environment. The Assessment of Life Habits for Children (LIFE-H) measured participation in home, school, and community life, and the Children Helping Out: Responsibilities and Expectations assessed children's participation in household duties. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were individualized tools used to evaluate goal achievement. Results showed most instruments had adequate reliability and validity. The COPM and GAS were the only measures that reported adequate responsiveness to detect clinically significant change. Limited data are currently available to determine the responsiveness of the CAPE, LIFE-H, and SFA. A combination of assessments is required to capture participation of children in home, school, and community environments.
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Affiliation(s)
- Leanne Sakzewski
- School of Physotherapy, La Trobe University, Bundoora, Australia.
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Odman P, Krevers B, Oberg B. Parents' perceptions of the quality of two intensive training programmes for children with cerebral palsy. Dev Med Child Neurol 2007; 49:93-100. [PMID: 17253994 DOI: 10.1111/j.1469-8749.2007.00093.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study explored parents' perceptions of the service quality of two intensive training programmes and the association between perceived service quality and predefined influential factors. Parents of 31 males and 19 females with spastic, dyskinetic, and ataxic cerebral palsy (mean age 8 y 7 mo [SD 3 y 7 mo]; range 3-16 y), and Gross Motor Function Classification System Level I n=1; Level II n=9; Level III n=8; Level IV n=20; and Level V n=12 were included. Functional outcome had been evaluated previously with the clinical measures Gross Motor Function Measure-88, the Pediatric Evaluation of Disability Inventory-Functional Skills, and the Self-reported Individualized Goal Measure, before and after a 4-week intensive training period (ITP). The two training programmes used were Lemo and Move&Walk. After the ITP, a telephone interview was performed with the same cohort, using the Patient perspective On Care and Rehabilitation process. Data on previous experiences, expectations, and severity of disability were collected before the ITP, and data on achieved expectations afterwards. Previous experiences of the training programme, high expectations of improvements, achieved expectations, gross motor capacity improvements, and intensive training at the child and youth rehabilitation centre were associated with increased probability of fulfillment of needs. Severity of disability was associated with decreased probability of fulfillment of needs and functional improvements. Most parents perceived high service quality, and achieved expectations were influenced by high service quality rather than by perceived functional improvements. This suggests that needs other than functional improvements must be explained and acknowledged.
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Affiliation(s)
- Pia Odman
- Department of Health and Society, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Abstract
The extent and nature of a child’s disability is determined, not only by their health condition and subsequent developmental deficits and activity limitations, but is also largely influenced by personal and environmental factors. Application of the International Classification of Functioning, Disability and Health, now widely endorsed internationally, greatly assists in the selection of assessment tools for children with a complex disorder such as cerebral palsy. This article provides an overview of the broad scope in which assessment should be framed, with examples of areas to evaluate and tools that may be considered for use. The target audience includes health professionals (medical and rehabilitation specialists) involved in the clinical management of children and youth with cerebral palsy.
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Affiliation(s)
- Annette Majnemer
- Montreal Children’s Hospital, McGill University Health Centre, School of Physical & Occupational Therapy, Departments of Neurology & Neurosurgery and Pediatrics, McGill University, Canada
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Abstract
Cerebral palsy (CP) is a common pediatric disorder occurring in about 2 to 2.5 per 1000 live births. It is a chronic motor disorder resulting from a non-progressive (static) insult to the developing brain. CP is the clinical presentation of a wide variety of cerebral cortical or sub-cortical insults occurring during the first year of life. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the commonest risk factor. Children with CP suffer from multiple problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Screening for these conditions should be part of the initial assessment. The child with CP is best cared for with an individualized treatment plan that provides a combination of interventions. This requires the provision of a number of family-centered services that make a difference in the lives of these children and their families. Management of spasticity can be challenging with a wide variety of possible therapeutic interventions. The treatment must be goal oriented, such as to assist with mobility, reduce or prevent contractures, improve positioning and hygiene, and provide comfort. Each member of the child's multidisciplinary team, including the child and both parents, should participate in the serial evaluations and treatment planning.
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Affiliation(s)
- Mohammed M S Jan
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.
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Abstract
Various therapeutic interventions have been used in the management of children with cerebral palsy. Traditional physiotherapy and occupational therapy are widely used interventions and have been shown to be of benefit in the treatment of cerebral palsy. Evidence in support of the effectiveness of the neurodevelopmental treatment is equivocal at best. There is evidence to support the use and effectiveness of neuromuscular electrical stimulation in children with cerebral palsy. The effectiveness of many other interventions used in the treatment of cerebral palsy has not been clearly established based on well-controlled trials. These include: sensory integration, body-weight support treadmill training, conductive education, constraint-induced therapy, hyperbaric oxygen therapy, and the Vojta method. This article provides an overview of salient aspects of popular interventions used in the management of children with cerebral palsy.
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Affiliation(s)
- Dilip R Patel
- Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, Michigan 49008, USA.
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Majnemer A, Mazer B. New directions in the outcome evaluation of children with cerebral palsy. Semin Pediatr Neurol 2004; 11:11-7. [PMID: 15132249 DOI: 10.1016/j.spen.2004.01.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article addresses newly emerging concepts regarding the examination of outcomes in children with cerebral palsy (CP). Three important factors have prompted a change toward a broader approach to outcome measurement: (1) the recent endorsement of the World Health Organization classification scheme of functioning, disability, and health; (2) recognition of the importance of the role of child and environmental factors in modifying outcome; and (3) appreciation of the challenges faced at key transitions during development. Comparison of the literature on outcomes in children with CP published in 2002 with studies published 10 years earlier demonstrates an increased number of studies and a wider range of outcome measures used to characterize the functioning of these children. A better understanding of the extent and nature of the outcomes and their determinants is critical to guide clinical decision making and program planning to maximize community integration, social participation, and overall well-being of the child and family.
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Affiliation(s)
- Annette Majnemer
- School of Physical & Occupational Therapy, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
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