The environmental barriers of children with Muscular Dystrophies and its effect on mother's low back pain

Assistive technology based on client-centered for occupational performance in neuromuscular conditions

Knowledge of the patient's own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence.This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home's accessibility level, and a specific questionnaire were administered.The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation = 17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users' homes (87.5%).Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver.

Comparison of musculoskeletal pain distribution, quality of life and hopelessness level in mothers with disabled children in different ambulation levels

OBJECTIVE

The aim of this study was to compare the musculoskeletal pain distribution, quality of life, and the hopelessness level in mothers with disabled children in different ambulation levels.

METHODS

This study included a total of 177 mothers (mean age: 36.1 ± 6.5 years) of children with disabilities. The mothers were divided into 3 different groups according to the ambulation level of their disabled children: Ambulatory children (Group 1), partially ambulatory children (Group 2) and non-ambulatory children (Group 3). Musculoskeletal pain distribution (body diagram) and pain intensity (The Visual Analogue Scale), four quality of life parameters (The Centers for Disease Control and Prevention Health-Related Quality of Life -4 Questionnaire) and hopelessness level (Beck Hopelessness Scale) were evaluated in all mothers.

RESULTS

The results of our study showed that musculoskeletal pain was most common (79.1%) in the mothers of disabled children. The frequency and severity of back, shoulder and elbow pain in the mothers, number of activity limitation days and hopelessness level were found to increase significantly as the ambulation level in the child decreased (p< 0.05).

CONCLUSIONS

The risk of musculoskeletal pain, participation in daily life and hopelessness level in the mothers increased as the ambulation level of the disabled children decreased.

Determining the burden of the family caregivers of people with neuromuscular diseases who use a wheelchair

The present study provides a basic outline of the care and support that family caregivers offer to people affected by neuromuscular diseases.To determine the presence of burden in caregivers of people with neuromuscular diseases who use a wheelchair and to establish whether the presence of burden is influenced by contextual factors, between them, the use of wheelchair.The applied design was cross-sectional and descriptive. The data were collected through a specific questionnaire, the Functional Independence Measure, the Matching Person and Technology form and the Zarit Burden Interview. The caregiver burden was analyzed in relation to different characteristics of the affected people, their wheelchairs, and factors related to the family caregivers themselves. The sample consisted of 41 caregivers, most of them (78.1%) being parents of the affected people.The burden was detected in 71.7% of caregivers. The level of dependence was not related to the presence of burden. Performing care work affected carers' physical health (80.5%), their mood (68.3%), and reduced their leisure time (90.2%). The type of wheelchair and the frequency of its use were not related to the burden.The results suggest that caregivers perceive burden, but its intensity is not related to the seriousness of the disease of the care receiver.

Quality of life in mothers of children with obstetrical brachial plexus palsy

BACKGROUND

The aim of this study was to explore impairment in quality of life (QOL) of the mothers who were primarily responsible for taking care of children with obstetrical brachial plexus palsy (OBPP) and to state its association with the age, sex and functional status of the child with OBPP.

METHODS

Ninety-three mothers of children with OBPP and 88 mothers of children without any health problems were included in the study. Children's demographic characteristics were recorded and the functional status of the upper extremity was determined with the active movement scale. The QOL of the mothers was assessed with the Turkish version of the Nottingham Health Profile (NHP).

RESULTS

There were significant differences between mothers of children with OBPP and the control group in total, physical activity, energy expenditure, and pain score of the NHP. A decrease in energy expenditure and physical activity levels were found to be related to children's active movement scale results in elbow flexion and extension, and forearm supination. A statistically meaningful difference was found between mothers of children aged 0-2 and mothers of children aged 2-7 years in emotional reaction, social isolation and total score of NHP.

CONCLUSIONS

The results of this study revealed that mothers of children with OBPP have poor QOL compared with mothers of healthy children. The limitation in elbow joint movements was found to be important for the mothers. The strongest impact of the illness is on the emotional reactions and social isolation of the mothers. Professionals involved in the care of children with OBPP should also help parents to cope with the burden of caregiving.

Mothers' depression and health-related quality of life in neuromuscular diseases: role of functional independence level of the children

BACKGROUND

In the literature there have been studies about quality of life of parents who have children with chronic diseases. Most of these studies have focused on the stress of parents of children with neuromuscular disease (NMD), and there was no evidence to support hypothesized relationships between caregiving demands and health-related quality of life (HRQOL). The aim of the present study was therefore to evaluate the relations between maternal depression and HRQOL and functional limitations of the children with NMD.

METHODS

Forty children with a diagnosis of NMD and their mothers were included in the study. HRQOL of the mothers was assessed on the Turkish version of the Nottingham Health Profile (NHP); potential cases of depressive illness were identified on Beck Depression Inventory (BDI); and Wee-Functional Independence Measure (Wee-FIM) was used to evaluate of functional independence level of the children.

RESULTS

It was found that mean total NHP score of the mothers was moderately correlated with the total FIM score and sphincter control of the child, and weakly correlated with the locomotion of the child (P < 0.001). There was moderate correlation between mothers' social isolation and children's sphincter control, social integration and total Wee-FIM score and a weak correlation between mobility and communication scores (P < 0.001). In contrast there was no correlation between BDI scores of mothers and Wee-FIM scores of children (P > 0.05).

CONCLUSION

The functional level of children with NMD is one of the factors that affect the quality of life of mothers.

Measurement of the functional status of patients with different types of muscular dystrophy

Muscular dystrophy (MD) comprises a group of diseases characterized by progressive muscle weakness that induces functional deterioration. Clinical management requires the use of a well-designed scale to measure patients' functional status. This study aimed to investigate the quality of the functional scales used to assess patients with different types of MD. The Brooke scale and the Vignos scale were used to grade arm and leg function, respectively. The Barthel Index was used to evaluate the function of daily living activity. We performed tests to assess the acceptability of these scales. The characteristics of the different types of MD are discussed. This was a multicenter study and included patients diagnosed with Duchenne muscular dystrophy (DMD) (classified as severely progressive MD), Becker muscular dystrophy (BMD), limb girdle muscular dystrophy (LGMD) and facioscapulohumeral muscular dystrophy (FSHD). BMD, LGMD, and FSHD were classified as slowly progressive MD. The results demonstrated that the Brooke scale was acceptable for grading arm function in DMD, but was unable to discriminate between differing levels of severity in slowly progressive MD. The floor effect was large for all types of slowly progressive MD (range, 20.0-61.9), and was especially high for BMD. The floor effect was also large for BMD (23.8%) and FSHD (50.0%) using the Vignos scale. Grades 6-8 of the Vignos scale were inapplicable because they included items involving the use of long leg braces for walking or standing, and some patients did not use long leg braces. In the Barthel Index, a ceiling effect was prominent for slowly progressive MD (58.9%), while a floor effect existed for DMD (17.9%). Among the slowly progressive MDs, FSHD patients had the best level of functioning; they had better leg function and their daily living activities were less affected than patients with other forms of slowly progressive MD. The results of this study demonstrate the acceptability of the different applications used for measuring functional status in patients with different types of MD. Some of the limitations of these measures as applied to MD should be carefully considered, especially in patients with slowly progressive MD. We suggest that these applications be used in combination with other measures, or that a complicated instrument capable of evaluating the various levels of functional status be used.

Electric powered wheelchairs for those with muscular dystrophy: problems of posture, pain and deformity

PURPOSE

To identify areas of difficulty encountered by a regional wheelchair service in providing Electric Powered Indoor/outdoor wheelchairs (EPIOCs) to those with muscular dystrophy (MD) in the early years of their provision--particularly posture, pain and deformity.

METHOD

Wheelchair service records of all users between April 1997 and March 2000 were reviewed retrospectively and issues relating to weakness, pain/discomfort, deformities, other medical issues, weight change, function, posture and driving were documented on a purpose-designed proforma. Adjustments and modifications were documented over the 2-year period following chair delivery.

RESULTS

Of 325 EPIOC users on the departmental database, 29 had MD (15 Duchenne's), whose users charts were reviewed. Almost 80% of users needed clinical review within 2 years, mostly due to a scoliosis. Other problems were postural (66%), medical (48%), pain (31%), functional (24%) and weight change (14%). The commonest prescriptions were for specialised seating (24%), lateral supports, headrests and footrests (21% each).

CONCLUSIONS

The rate of disease progression was not planned for by the service. Most clients were seen in response to deterioration, rather than anticipating it. Planned reviews within 1 year appear essential for teenagers with MD with the dual issues of rapid maturation and progressive disease.

Parental experience of home adaptation for children with motor disabilities

Home adaptation is essential in increasing independence of children with disabilities and reducing the burden of care for parents. Physical and occupational therapists involved in home adaptations are faced with various challenges in meeting the needs and expectations of parents. This study aimed at exploring the experience of parents throughout the home adaptation process. We conducted an exploratory qualitative study, whereby we interviewed a sample of 11 parents of children with motor disabilities, using focus groups and individual interviews. Dominant themes that emerged were financial and organizational constraints, child's independence/self-esteem, respect of temporal aspects, safety, respect for parent's roles, need for information, and appearance of the home. Parents wish physical and occupational therapists to take on roles that extend beyond provision of home adaptation, such as those of consultants and advocates.

Les aidants familiaux des personnes myopathes : liaisons entre charge de soins, qualité de vie et santé mentale

OBJECTIVE

The analysis of caregiver difficulties seems important to define the life of the patient. The aim of the study was to evaluate the burden of perceived care, health-related quality of life, and mental health of family caregivers who care for patients with hereditary neuromuscular disease.

MATERIALS AND METHOD

Fifty-nine family caregivers were investigated in the course of multidisciplinary consultations in Reims, France, between April 2002 and February 2005. Burden of perceived care, mental functioning and mental health were measured by answers to an burden interview instrument (Zarit Burden Inventory, ZBI), a health-related quality of life questionnaire (the SF-36 and General Health Questionnaire-12 items [GHQ-12]), and an instrument quantifying anxiety and depression (Hospital Anxiety and Depression scale [HAD]). The domain scores of the SF-36 were compared with those of the general population. Non-parametric correlations between scores were calculated.

RESULTS

Thirty-five parents, 20 spouses, a sister, a grandmother and two friends cared for patients with hereditary myopathy. The average age of caregivers was 50+/-11 years; 81% were women. Ten percent of the caregivers had above-normal scores on the HAD scale, One-third perceived a significant reduction in health-related quality of life, and more half expressed a moderate or important burden according to their answers on the ZBI. Depression occurred in a great proportion of the caregivers, and they showed reduced health-related quality of life as compared with the general population.

CONCLUSION

Taking into account these results, it appears useful to set up a specific support for family caregivers of patients with hereditary myopathy.