Lifestyle limitations of children and young people with severe cerebral palsy: a population study protocol

Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

BACKGROUND

Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue. This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3-25 years compared to age-matched typically developing (TD) subjects.

METHODS

Fifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects.

RESULTS

The MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI. None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI.

CONCLUSIONS

These results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity.

TRIAL REGISTRATION

ClincalTrials.gov, NCT03054441 . Registered 15 February 2017.

Quality of life as assessed by adults with cerebral palsy

Aim

We explored the quality of life of adults with cerebral palsy without an intellectual disability and the predictors of quality of life.

Background

Because cerebral palsy is a disease that manifests in childhood, much of the research into quality of life for those dealing with it focuses on children; there are few studies that evaluate the quality of life of adults with cerebral palsy. Therefore, it is important to consider their perceptions in order to improve their general wellbeing and self-determination.

Design

This was a descriptive, cross-sectional study.

Method

Quality of life was measured using the GENCAT Quality of Life Scale. Demographic and personal variables were also collected and examined. Participants comprised 75 adults (58.7 percent men, mean age = 40.84 years) with cerebral palsy who were members of the National Cerebral Palsy Association of Spain between 2014 and 2015. A linear multivariate model was examined as well.

Results

The overall mean score indicator of participants’ quality of life was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. Examining the level of qualification, we found significant differences in the factors “personal development” and “self-determination,” and those with a university education obtained higher scores than their less-educated counterparts. Having a partner was related to higher quality of life standard scores. After constructing a linear model, it was observed that maintaining sexual relationships was another factor that increased participants’ quality of life.

Conclusion

This study highlights the importance of social and romantic relationships to achieve a better quality of life in adults with cerebral palsy who do not have an intellectual disability. Social integration and sexuality education programs should be developed to improve their quality of life.

Cross-cultural translation and adaptation to Brazilian Portuguese of the paediatric pain profile in children with severe cerebral palsy

CONTEXT

Pain is a prevalent symptom in children with severe cerebral palsy (CSCP), mainly as a result of the progression of muscle contractures, bone deformities, gastroesophageal reflux, and recurrent infections. Considering the lack of verbal communication in this population, both pain diagnosis and assessment of the analgesic treatment are often neglected. Although the Paediatric Pain Profile (PPP), an instrument with 20 items, is used to assess behavior indicative of pain in CSCP, it is not validated in Brazil.

OBJECTIVES

To translate, adapt, and evaluate the psychometric properties of the PPP to Brazilian Portuguese.

METHODS

The study was carried out at a philanthropic institution for CSCP and a university hospital. The sample of CSCP unable to communicate through speech or any device, their respective parents or primary caregivers, and health professionals were included. First, the instrument was translated and then back translated, and its clarity was evaluated by parents, primary caregivers, and professionals. The psychometric properties of the final version were evaluated for internal consistency (Cronbach's α) and stability (test-retest).

RESULTS

Forty-five children with a mean (SD) chronological age of 16 (8.69) years, 26 of whom were male, were included in the study. A total of 150 applications of PPP were carried out: 30 to assess clarity and 120 to assess the psychometric properties. Each item of the translated version showed a median between 3.00 and 4.00, considered to be clear and very clear, respectively. The internal consistency of the items was α=0.864, with no significant difference between test and retest (P=0.271).

CONCLUSION

The adapted version of the PPP in Brazilian Portuguese demonstrated good internal consistency (similar to the original instrument) and stability over time, decisive for the next step of clinical validation for CSCP.

Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol

AIM

This paper outlines the protocol for a study aimed at exploring parent's involvement during professional-parent interactions and decisions about their child's care in the context of suspected shunt malfunction.

BACKGROUND

Hydrocephalus is a long-term condition treated primarily by the insertion of a shunt that diverts fluid from the brain to another body compartment. Shunts frequently malfunction, and parents of children with shunted hydrocephalus are responsible for recognizing and responding to shunt complications. Parents feel that interactions with professionals when they seek healthcare advice for their child do always not encourage active participation in care decisions.

METHODS

The study design is based on qualitative methodologies: a combination of conversation analysis applied to consultation recordings of professional-parent interactions when a child is admitted to hospital with suspected shunt malfunction, and semi-structured follow-up interviews with the same participants within 2 weeks of the consultation.

PARTICIPANTS

This is a prospective study and participants will be purposefully selected. Parents of children who have been admitted to hospital with suspected shunt malfunction and healthcare professionals responsible for the initial assessment of the child will be invited to participate.

DISCUSSION

The study will identify how decisions about a child's care are negotiated between parents and healthcare professionals at key stages of the care pathway. In addition, examining interactions between healthcare professionals and parents may identify approaches that support or hinder parents in contributing to the decision-making processes when they seek advice from healthcare professionals.