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Pham VM, Hoang TL, Hoang KC, Nguyen NM, DeLuca SC, Coker-Bolt P. The effect of constraint-induced movement therapy for children with hemiplegic cerebral palsy in Vietnam. Disabil Rehabil 2024:1-7. [PMID: 38828697 DOI: 10.1080/09638288.2024.2360060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Pediatric constraint-induced movement therapy (CIMT) is an evidence-based treatment that has a long history of demonstrating efficacy for children with hemiparesis. The purpose of this study is to determine the effectiveness of a culturally responsive CIMT program for children with hemiplegic cerebral palsy (CP) developed for the Vietnam healthcare system. METHODS Thirty children with hemiplegic CP (mean age = 2.88 years, age range: 1 to 8 yrs, 60% male) were recruited to a CIMT program (7.5 h/week, 4 weeks) developed for the cultural context of Vietnam. Motor abilities of the affected arm and participation in daily activities were evaluated at 3 time points (one-week prior to CIMT (baseline), one-week before (pre) and after (post) CIMT) using the Quality of Upper Extremity Skill Test (QUEST) and Pediatric Motor Activity Log-Revised (PMAL-R). Individual goals were measured using the Goal Attainment Scale (GAS). RESULTS There were significant increases in the "How often scale" and "How Well" scales of the PMAL-R (0.75 and 0.75, p < 0.00)). Score of Grasp and Dissociated Movement items on the QUEST increased significantly (6.47 and 7.63, p < 0.001). Group GAS T-Scores were 52.19 indicating that children met individual goals. CONCLUSIONS A model of CIMT was successfully developed and delivered within the Vietnamese healthcare system. Future studies should explore the optimal model for CIMT in various regions of world where the delivery of rehabilitation services may vary.
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Affiliation(s)
- Van Minh Pham
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Thi Lien Hoang
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Khanh Chi Hoang
- Rehabilitation Department, Ha Noi Medical University, Hanoi, Vietnam
- Ha Noi Rehabilitation Hospital, Hanoi, Vietnam
| | - Ngoc-Minh Nguyen
- Rehabilitation Department, Nursing and Medical Technology Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
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Mulqueeney A, Battin M, McKillop A, Stott NS, Allermo-Fletcher A, Williams SA. A prospective assessment of readiness to implement an early detection of cerebral palsy pathway in a neonatal intensive care setting using the PARIHS framework. Implement Sci Commun 2024; 5:46. [PMID: 38654322 PMCID: PMC11036598 DOI: 10.1186/s43058-024-00581-0] [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: 10/26/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Early detection of cerebral palsy (CP) is possible through targeted use of assessment tools. Changes in practice are needed to facilitate this shift towards earlier diagnosis of CP in New Zealand. The aim of this study was to prospectively evaluate readiness to implement an early detection of CP pathway within a level 3 neonatal intensive care unit (NICU) setting prior to any implementation taking place. The PARIHS (Promoting Action on Research Implementation in Health Services) framework was engaged to assess readiness by highlighting determinants that influence implementation outcomes as either barriers or enablers. METHODS A mixed methods approach was used. Firstly, an online staff survey assessed PARIHS sub-elements using Likert scores and free text with the intent to develop a baseline understanding of staff views. Secondly, focus groups were conducted to gain deeper understanding of barriers and enablers to implementation. Participants included health professionals involved in the first 6 months of life. Data were analysed to outline the barriers and enablers of implementation under the Evidence and Context constructs of the PARIHS framework. RESULTS Twenty-seven participants completed the survey, and 20 participants participated in eight focus groups and two individual interviews. Quantitative (survey) findings found 65% agreement around the usefulness of research evidence on early CP detection; however, ≤ 45% felt current resources (i.e. human, financial and IT) were sufficient for implementation. Qualitative findings (survey and focus groups) highlighted key staff concerns around resources, family impact (creating unnecessary stress), and equity (barriers to participation). Staff wanted information regarding how international evidence translates to the local context and availability of timely follow-up services. Sub-elements within the Evidence and Context constructs were rated as either mixed or low (except for Evidence - Research, rated as high), overall indicating that Auckland NICU is at the early stages of readiness to implement the early CP detection pathway. CONCLUSION This work may resonate with other neonatal services preparing to implement CP early detection pathways. Resourcing has a major role in facilitating implementation of pathways and uncertainty about resources is a barrier to implementation. Ongoing focus on building consensus and funding is required to ensure optimal uptake.
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Affiliation(s)
- Amy Mulqueeney
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand
| | - Malcolm Battin
- Newborn Services, Starship Child Health, Te Toka Tumai - Auckland, Te Whatu Ora, Auckland, New Zealand.
- Faculty of Medical and Health Sciences, Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.
| | - Ann McKillop
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Sîan A Williams
- School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Benfer KA, Whittingham K, Ware RS, Ghosh AK, Chowdhury S, Moula G, Samanta S, Khan NZ, Bell KL, Oftedal S, Bandaranayake S, Salt AT, Bhattacharya A, Maiti P, Tripathi SK, Morgan C, Novak I, Boyd RN. Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT. Pediatrics 2024; 153:e2023063854. [PMID: 38516717 DOI: 10.1542/peds.2023-063854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. METHODS This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. RESULTS Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. CONCLUSIONS Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sayak Chowdhury
- Indian Institute of Cerebral Palsy, Kolkata, India
- SSKM Postgraduate Institute of Medical Education and Research, Kolkata, India
| | | | - Sandip Samanta
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Kristie L Bell
- Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Sasaka Bandaranayake
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
| | | | | | - Pradip Maiti
- Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Kukka AJ, Sundelin HEK, Basnet O, Paudel P, Upadhyay Subedi K, Svensson K, Brown N, Litorp H, Gurung R, Bhattarai P, Wrammert J, Kc A. NeuroMotion smartphone application for remote General Movements Assessment: a feasibility study in Nepal. BMJ Open 2024; 14:e080063. [PMID: 38431302 PMCID: PMC10910581 DOI: 10.1136/bmjopen-2023-080063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal. METHOD Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women's Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months' age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl's General Movements Assessment. The usability of the application was evaluated through a parental survey. RESULTS Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive. INTERPRETATION Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country.
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Affiliation(s)
- Antti Juhani Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Heléne E K Sundelin
- Division of children's and women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Katarina Svensson
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Nick Brown
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rejina Gurung
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Golden Community, Lalitpur, Nepal
| | | | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Sturrock S, Sadoo S, Nanyunja C, Le Doare K. Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations. Res Rep Trop Med 2023; 14:121-134. [PMID: 38116466 PMCID: PMC10728307 DOI: 10.2147/rrtm.s410785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.
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Affiliation(s)
- Sarah Sturrock
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Nanyunja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
- UK Health Security Agency, Salisbury, UK
- Makerere University, Johns Hopkins University, Kampala, Uganda
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Benfer K, Boyd RN, Roe Y, Fagan R, Luke C, Mick-Ramsamy L, Whittingham K, Novak I, Bosanquet M, McNamara L, Khandaker G, Fogarty L, Cadet-James Y, Ruben A, Comans T, Smith A, Ware RS. Study protocol: peer delivered early intervention (Learning through Everyday Activities with Parents for Infants at risk of Cerebral Palsy: LEAP-CP) for First Nation Australian infants at high risk of cerebral palsy - an RCT study. BMJ Open 2023; 13:e059531. [PMID: 36914182 PMCID: PMC10016288 DOI: 10.1136/bmjopen-2021-059531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). METHODS AND ANALYSIS This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP ('absent fidgety' on General Movements Assessment, and/or 'suboptimal score' on the Hammersmith Infant Neurological Examination) aged 12-52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. SAMPLE SIZE total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition). ETHICS AND DISSEMINATION Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167p.
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Affiliation(s)
- Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Yvette Roe
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Ruth Fagan
- Research, Gurriny Yealamucka Health Service, Yarrabah, Queensland, Australia
| | - Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Gulam Khandaker
- Public Health Unit, Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Queensland, Australia
| | - Lucy Fogarty
- Department of Physiotherapy, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Research, Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Alan Ruben
- Child, Youth, and Family Health, Cape and Torres Strait Hospital and Health Service, Cairns, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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8
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Implementation of Early Detection and Intervention for Cerebral Palsy in High-Risk Infant Follow-Up Programs: U.S. and Global Considerations. Clin Perinatol 2023; 50:269-279. [PMID: 36868710 DOI: 10.1016/j.clp.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Early detection and intervention for cerebral palsy is best practice for all high-risk infants according to international guidelines, consensus statements and research-supported evidence. It allows support for families and optimization of developmental trajectories into adulthood. All phases of implementation of CP early detection can be found across the world in high-risk infant follow-up programs, demonstrating feasibility and acceptability through standardized implementation science. The largest clinical network for CP early detection and intervention in the world has now sustained an average age at detection less than 12 months corrected age for more than 5 years. Targeted referrals and interventions for CP can now be offered to patients in optimal periods of neuroplasticity, and new therapies researched as the age of detection decreases. Implementation of guidelines and incorporation of rigorous CP research studies both allow high-risk infant follow-up programs to fulfill their mission of improving outcomes of those with the most vulnerable developmental trajectories from birth.
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9
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Martinez AR, Turpin M, McGloon K, Coker-Bolt P. Rehabilitation for Pediatric Stroke in Low and Middle Income Countries: A Focused Review. Semin Pediatr Neurol 2022; 44:101000. [PMID: 36456036 DOI: 10.1016/j.spen.2022.101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Rehabilitation for pediatric stroke survivors can maximize a child's potential through each developmental stage of life. Timely diagnosis and referral to a rehabilitation specialist may harness opportunities to maximize brain plasticity, to help children adapt and learn, and to participate in and enjoy daily life to their capability. The aim of this focused review is to explore current rehabilitation models and evidence-based interventions for pediatric stroke survivors in Low- and Middle- Income Countries (LMICs) and to provide recommendations for future research and focused areas of improvement.There are several published pediatric stroke guidelines from the American Heart Association (AHA), Canada, Australia, and the United Kingdom (UK) which provide specific recommendations for rehabilitation, although the suggested intervention and services vary. There are no current guidelines developed in or contextually adapted for LMICs, although the current pediatric stroke guidelines emphasize the need to develop interventions that fit the cultural and environmental contexts. The World Health Organization (WHO) Rehabilitation 2030 initiative acknowledges profound unmet rehabilitation needs around the world, especially in LMICs. According to the WHO, LMICs have less than ten skilled rehabilitation professionals per one million people. Enhancing the understanding of rehabilitation services in LMICs could lead to nationally supported workforce education initiatives targeted to expand the number of locally trained therapy providers. This could improve access to and delivery of quality rehabilitation interventions to pediatric stroke survivors in these settings.
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10
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Chen D, Wu Y, Li H, Pan X, Zhou J. Treatment on patients with spastic cerebral palsy in the past 30 years: A systematic review and bibliometric analysis. Medicine (Baltimore) 2022; 101:e30535. [PMID: 36397367 PMCID: PMC9666139 DOI: 10.1097/md.0000000000030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past 30 years, treatments from different disciplines have been applied to spastic cerebral palsy (SCP). However, few bibliometric studies have been conducted to date. This study explored the knowledge base, emerging hotspots, and future trends related to SCP treatment research using bibliometric analysis. METHODS Publications on SCP treatment included in the Web of Science Core Collection database between 1990 and 2020 were retrieved, and Medical Subject Headings terms were extracted from PubMed. Online bibliometric analysis website (http://bibliometric.com/), 2 pieces of software called "CiteSpace" and "VOSViewer" were used for quantitative analysis and knowledge map establishment. RESULTS A total of 1668 papers were retrieved from 1990 to 2020. The number of publications has increased annually. Developmental Medicine and Child Neurology is the most productive and the highest co-cited journal. The United States has been the largest contributor. Vrije Universiteit Amsterdam ranked first in the number of papers published among institutions that have conducted correlational research. Becher JG and Graham HK should be considered scholars who have made outstanding contributions. The knowledge base of the SCP treatment research field is thoughtfully constructed to promote understanding of the field. CONCLUSION This bibliometric study identified global achievements, research hotspots, and trends of SCP treatment. They provide insights into the research field and valuable information for future scientific research and clinical treatment.
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Affiliation(s)
- Dingfang Chen
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Yuefeng Wu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - HaiYing Li
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Xue Pan
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Jin Zhou
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Jin Zhou, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
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11
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Pietruszewski L, Moore-Clingenpeel M, Moellering GCJ, Lewandowski D, Batterson N, Maitre NL. Predictive value of the test of infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants. Early Hum Dev 2022; 174:105665. [PMID: 36126506 DOI: 10.1016/j.earlhumdev.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current recommendations for early detection tools for cerebral palsy (CP) include assessments that vary in feasibility and resource requirements. The predictive value of less resource-intensive tools has not been fully explored. AIMS To determine the predictive value of the Test of Infant Motor Performance (TIMP) at 3-4 months corrected age (CA) for CP, and whether administration of both the TIMP and the Hammersmith Infant Neurological Exam (HINE) improves early CP detection. STUDY DESIGN Five-year retrospective observational study of infants who received the TIMP and the HINE at 3-4 months CA in a high-risk follow-up clinic. TIMP and HINE cut-off scores (alone and in combination) were compared for CP discriminatory ability. SUBJECTS Of patients with HINE scores (n = 1389; 676 [48.7 %] female; median gestational age at birth 31 weeks [interquartile range 29-34 weeks]), 1343 had concurrent TIMP scores available. OUTCOME MEASURES Clinical diagnosis of CP. RESULTS HINE total score <57 had optimal CP predictive value (AUC = 0.815; 77 % sensitivity; 91 % specificity) compared to optimal TIMP cut-off (1 SD below the mean, AUC = 0.71; 52 % sensitivity; 94 % specificity) and all tested TIMP and HINE combinations (all p < 0.001). CONCLUSIONS HINE total score <57 at 3-4 months CA had the best CP predictive value, confirming its value absent first-line detection tools. Concurrent administration of TIMP did not improve predictive value.
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Affiliation(s)
- Lindsay Pietruszewski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA.
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | | | - Dennis Lewandowski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA
| | - Nancy Batterson
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA
| | - Nathalie L Maitre
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA 30322, USA
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12
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Branjerdporn N, Benfer K, Crawford E, Ziviani J, Boyd RN, Sakzewski L. Efficacy of early interventions with active parent implementation in low-and-Middle income countries for young children with cerebral palsy to improve child development and parent mental health outcomes: a systematic review. Disabil Rehabil 2022; 44:6969-6983. [PMID: 34647839 DOI: 10.1080/09638288.2021.1989063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine the efficacy of interventions with active parent implementation for young children with cerebral palsy (CP) to improve child and parent outcomes in low-middle income countries (LMICs). METHODS Five databases were systematically searched. Randomised or comparison studies evaluating interventions with the training of the parent and/or home practice components to implement with their child with CP (<60 months of age) were included. The modified Downs and Black scale assessed methodological quality. Data were pooled to calculate mean differences and 95% confidence intervals (95% CI). RESULTS Searches yielded 189 unique articles. 11 studies from ten papers of moderate to high quality were included. Parent-implemented general developmental interventions had a small negative effect on gross motor function compared to interventionist-implemented therapy. Parent-implemented upper limb training compared to interventionist-implemented neurodevelopmental therapy had a small positive effect on bimanual hand function. Parent-implemented functional feeding training had a large significant effect on chewing function compared to parent-implemented oral motor exercises. Parent-implemented interventions targeting general child development and feeding had mixed effects on parent stress outcomes. CONCLUSIONS Parent-implemented interventions in LMICs are promising to improve child bimanual hand and chewing function. Further research evaluating the efficacy of parent-implemented interventions to improve parent mental health is needed.Implications for Rehabilitation:Intensive motor training-based interventions with active parent implementation were effective to improve child gross motor, bimanual hand, and chewing function in young children with CP compared to passive, generic interventionist-implemented or health education interventions.Interventions with active parent implementation had mixed results to improve parent mental health, however, this was frequently not assessed. A consistent level of support and training provided to parents may be required to have a positive effect on parent stress.To further understand the feasibility of early interventions with active parent implementation in LMICs, data on adherence to home practice dose and session attendance and a qualitative understanding of contextual and child factors influencing parent implementation is needed.
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Affiliation(s)
- Nataya Branjerdporn
- Faculty of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
| | - Katherine Benfer
- Faculty of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
| | - Emma Crawford
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Faculty of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
| | - Leanne Sakzewski
- Faculty of Medicine, The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Brisbane, Australia
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Carvalho A, Longo E, Nascimento-Carvalho C, Argollo N, Coelho KE, Sampaio A, Brites C, Lucena R. Do Children With Congenital Zika Syndrome Have Cerebral Palsy? GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00575. [PMID: 36316149 PMCID: PMC9622294 DOI: 10.9745/ghsp-d-21-00575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Abstract
As researchers and practitioners, we have an important role in educating families of children with brain damage caused by Zika virus infection on how a cerebral palsy diagnosis can empower them with more information and enable better access to care and intervention services.
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Affiliation(s)
- Alessandra Carvalho
- SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil.,Correspondence to Alessandra Carvalho ()
| | - Egmar Longo
- Trairi Health Sciences Faculty (FACISA), Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | | | | | | | - Aline Sampaio
- Federal University of Bahia, Salvador, Bahia, Brazil
| | - Carlos Brites
- Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rita Lucena
- Federal University of Bahia, Salvador, Bahia, Brazil
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14
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Pahwa PK, Mani S. Current Profile of Physical Impairments in Children with Cerebral Palsy in Inclusive Education Settings: A Cross-Sectional Study. J Neurosci Rural Pract 2022; 13:424-430. [PMID: 35946009 PMCID: PMC9357468 DOI: 10.1055/s-0042-1744556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Cerebral palsy (CP) excerpts a heterogeneous corral of neurological disorders occurring due to injury to the developing brain leading to motor dysfunctions. The CP children enjoy success and progress in normal school education and curriculum program. The principle of inclusive education has been acknowledged over recent decades in all countries supporting the schooling of children with disabilities into mainstream settings for constructing an inclusive society.
Objective
The objective of this study was to determine the current status of physical impairments in children with CP in inclusive education settings in district Mandi, Himachal Pradesh.
Materials and Methods
A survey using the physical examination of all CP children (
n
= 20) between the age group of 6 and 12 years in inclusive education settings with an organized interview of special educators in school settings was conducted. Descriptive analysis was conducted by using SPSS IBM 22.
Results
A total of 20 CP children (11 boys and 9 girls, with the mean age of 9.8 ± 1.69) were enrolled in the study. Mean and standard deviation of Visual Analog Scale (6.5 ± 0.82), Pediatric Balance Scale (21.4 ± 17.1), Gross Motor Function Classification System, Expanded and Revised (2.8 ± 1.46), Manual Ability Classification System (2.5 ± 1.1), Gross Motor Function Measurement-88 (36.40 ± 22.94), and Goal Attainment Scale (35.9 ± 0.40) with the total WeeFIM score (75.7 ± 3.4) were analyzed as the score of all outcome measures.
Conclusion
Right to Education act promotes the compulsory education of such children, and limiting disability by knowing the current profile of impairments could help in improving physical and functional status in children.
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Affiliation(s)
- Pardeep K. Pahwa
- Department of Physiotherapy, Composite Regional Centre (CRC) for Skill Development, Rehabilitation and Empowerment of Persons with Disabilities, Under Ministry of Social Justice and Empowerment, Government of India, Mandi, Himachal Pradesh, India
| | - Suresh Mani
- Department of Physiotherapy, Lovely Professional University, Phagwara, Punjab, India
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15
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Early Diagnosis of Cerebral Palsy in Low- and Middle-Income Countries. Brain Sci 2022; 12:brainsci12050539. [PMID: 35624926 PMCID: PMC9138742 DOI: 10.3390/brainsci12050539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
Cerebral palsy describes a group of permanent disorders of movement, motor function and posture that occur due to non-progressive insults to the developing brain. Most of the information concerning the early diagnosis of cerebral palsy originates from studies conducted in high-income countries. In this scoping review, we aimed to explore the tools used in low- and middle-income countries for the early diagnosis of cerebral palsy. A systematic search was conducted using OVID Medline and PubMed databases. “Early diagnosis” was defined as diagnosis prior to 12 months of age, and low- and middle-income countries were classified according to the World Bank classification system. We identified nine studies on the early diagnosis of cerebral palsy from low- and middle-income countries. The tools featured (n = number of studies) were: General Movement Assessment (6), neonatal magnetic resonance imaging (3), Hammersmith Neonatal Neurological Examination (2), Hammersmith Infant Neurological Examination (1) and cranial ultrasound (1). We found a paucity of published literature on the early diagnosis of cerebral palsy from low- and middle-income countries. Further research is needed to determine the tools that are accurate and feasible for use in low-resource settings, particularly since cerebral palsy is more prevalent in these areas.
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Al Imam MH, Das MC, Jahan I, Muhit M, Akbar D, Badawi N, Khandaker G. A Social Business Model of Early Intervention and Rehabilitation for People with Disability in Rural Bangladesh. Brain Sci 2022; 12:brainsci12020264. [PMID: 35204026 PMCID: PMC8869949 DOI: 10.3390/brainsci12020264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Despite the high burden of childhood disability in low-and middle-income countries (LMICs), the opportunity for early intervention and rehabilitation is very limited. Studies have found that community-based rehabilitation service is effective for children with cerebral palsy (CP); however, such services are not readily available in LMICs, and services run by non-profit organisations on external funding are often not sustainable. In this study, we report the lesson learnt in establishing a social business model of early intervention and rehabilitation services for children with CP and adults with disabilities in a rural subdistrict of Bangladesh. Methods: Case study of a rural early intervention and rehabilitation centre (i.e., the model centre) implemented between May 2018 and September 2019. An economic evaluation incorporating gross margin analysis along with descriptive statistics was performed to assess the social business potentials of the model centre. Results: The establishment of this model centre cost ~5955 USD with an average monthly running cost of ~994 USD. During the 17 months study period, 7038 therapy sessions (average eight sessions per patient) were offered to 862 patients with musculoskeletal and neurological disorders. The most common clinical presentations were low back pain (35.6%; n = 307). Six percent (n = 52) of the attendees were children with CP (mean (SD) age 6.3 (4.0) years; 35.7% (n = 19) were female), who received 1392 sessions, on average 27 sessions per child. The centre reached the break-even point at the 13th month and remained profitable for the next 4 months of the study period. An average session fee of 2.2 USD resulted in a gross margin of -1458 USD and 1940 USD in 2018 and 2019, respectively. Revenue to cost ratios for the 2 years were 0.27:1 and 0.51:1 while average rates of return were −41.4% and 10.1%, respectively. Sensitivity analysis revealed that session numbers including 5000, 6000, 7000, 8000, 9000, and 10,000 were required to break even at the session fees of 3.0, 2.50, 2.0, 2.0, 1.5, and 1.5 USD, respectively. Conclusion: Our social business model of an early intervention and rehabilitation service provides evidence of enhancing access to services for children with CP as well as adults with disabilities while ensuring the sustainability of the services in rural Bangladesh.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (M.H.A.I.); (M.C.D.); (I.J.); (M.M.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1213, Bangladesh
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, QLD 4701, Australia;
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, NSW 2050, Australia;
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia
- Correspondence: ; Tel.: +61-7-49206989
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Al Imam MH, Jahan I, Muhit M, Das MC, Power R, Khan A, Akbar D, Badawi N, Khandaker G. Supporting Ultra Poor People with Rehabilitation and Therapy among families of children with Cerebral Palsy in rural Bangladesh (SUPPORT CP): Protocol of a randomised controlled trial. PLoS One 2021; 16:e0261148. [PMID: 34972100 PMCID: PMC8719685 DOI: 10.1371/journal.pone.0261148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Poverty is a key contributor to delayed diagnosis and limited access to early intervention and rehabilitation for children with cerebral palsy (CP) in rural Bangladesh. 97% of families of children with CP live below the poverty line in Bangladesh. Therefore, in low-and middle-income countries (LMICs), efforts to improve outcomes for children with CP (including health-related quality of life, motor function, communication, and nutritional attainments) should also include measures to improve family economic and social capital. We propose a randomised controlled trial (RCT) to evaluate the effectiveness of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) program for ultra-poor families of children with CP in rural Bangladesh. MATERIAL AND METHODS This will be a cluster RCT comparing three arms: (a) integrated microfinance/livelihood and community-based rehabilitation (IMCBR); (b) community-based rehabilitation (CBR) alone; and (c) care-as-usual (i.e. no intervention). Seven clusters will be recruited within each arm. Each cluster will consist of 10 child-caregiver dyads totalling 21 clusters with 210 dyads. Parents recruited in the IMCBR arm will take part in a microfinance/livelihood program and Parent Training Module (PTM), their children with CP will take part in a Goal Directed Training (GDT) program. The programs will be facilitated by specially trained Community Rehabilitation Officers. The CBR arm includes the same PTM and GDT interventions excluding the microfinance/livelihood program. The care-as-usual arm will be provided with information about early intervention and rehabilitation. The assessors will be blinded to group allocation. The duration of the intervention will be 12 months; outcomes will be measured at baseline, 6 months, 12 months, and 18 months. CONCLUSION This will be the first RCT of an integrated microfinance/livelihood and CBR program for children with CP in LMIC settings. Evidence from the study could transform approaches to improving wellbeing of children with CP and their ultra-poor families.
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Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Rosalie Power
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, New South Wales, Australia
| | - Arifuzzaman Khan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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DAMIANO DIANEL, LONGO EGMAR. Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews. Dev Med Child Neurol 2021; 63:771-784. [PMID: 33825199 PMCID: PMC9413025 DOI: 10.1111/dmcn.14855] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/15/2022]
Abstract
AIM To perform an overview of systematic reviews and more recent randomized controlled trials (RCTs) on early motor interventions in infants aged 0 to 3 years with or at risk of cerebral palsy to inform current clinical and research efforts and provide a benchmark to assess future interventions ideally initiated within the first 6 months. METHOD Standardized searches of the PubMed, Embase, Scopus, and Web of Science databases were conducted for systematic reviews (2009-2020) and RCTs (2015-2020). RESULTS From 840 unique records, 31 full texts were reviewed, yielding three systematic reviews encompassing 46 studies, 16 with comparison groups, and six additional RCTs that met the criteria. Two enrichment- and activity-based approaches had medium effect sizes on motor development, only one with low risk of bias; two others had large task-specific effect sizes but some bias concerns; and three enriched environment studies with some bias concerns had medium effect sizes on cognitive development. Most had small or no effect sizes, bias concerns, and uncertain diagnostic determinations. INTERPRETATION Data synthesis revealed limited data quantity and quality, and suggest, although not yet confirmed, greater benefit from early versus later intervention. Research efforts with greater early diagnostic precision and earlier intervention are accelerating, which may transform future outcomes and practices. What this paper adds For over 50% of trials within the reviews, the intervention was compared to standard care with only two showing efficacy. Similar to results in older children, constraint-induced movement therapy (CIMT) emerged as efficacious with high effect sizes. CIMT was not superior to similarly intense bimanual training or occupational therapy. Goals-Activity-Motor Enrichment intervention initiated before 5 months of age was superior to equally intense standard care. Several other enriched environment strategies promoted cognitive and/or motor development.
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Affiliation(s)
| | - EGMAR LONGO
- Health of Children, Federal University of Rio Grande do Norte/Faculty of Health Sciences of Trairi-UFRN/FACISA, Santa Cruz, Brazil
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Smythe T, Zuurmond M, Tann CJ, Gladstone M, Kuper H. Early intervention for children with developmental disabilities in low and middle-income countries - the case for action. Int Health 2021; 13:222-231. [PMID: 32780826 PMCID: PMC8079317 DOI: 10.1093/inthealth/ihaa044] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/22/2022] Open
Abstract
In the last two decades, the global community has made significant progress in saving the lives of children <5 y of age. However, these advances are failing to help all children to thrive, especially children with disabilities. Most early child development research has focussed on the impact of biological and psychosocial factors on the developing brain and the effect of early intervention on child development. Yet studies typically exclude children with disabilities, so relatively little is known about which interventions are effective for this high-risk group. In this article we provide an overview of child development and developmental disabilities. We describe family-centred care interventions that aim to provide optimal stimulation for development in a safe, stable and nurturing environment. We make the case for improving opportunities for children with developmental disabilities to achieve their full potential and thrive, including through inclusive early childhood development intervention. Finally, we call for the global research community to adopt a systematic approach for better evidence for and implementation of early interventions for children with developmental disabilities in low-resource settings.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Maria Zuurmond
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7TX, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Branjerdporn N, Crawford E, Ziviani J, Boyd RN, Benfer K, Sakzewski L. Mothers' perspectives on the influences shaping their early experiences with infants at risk of cerebral palsy in India. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 113:103957. [PMID: 33866079 DOI: 10.1016/j.ridd.2021.103957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Accurate diagnosis of cerebral palsy (CP) high-risk status is now possible in infants less than six months corrected age. Parents play a central role in providing nurturing care and implementing early intervention approaches. To design interventions tailored to needs of parents and understand how to improve parental support, this study aimed to understand the influences shaping parent experiences with an infant at high-risk of CP in West Bengal, India. METHODS AND PROCEDURES This phenomenological qualitative study was conducted with parents of infants at high-risk of CP in West Bengal, India. Individual in-depth interviews explored experiences with health providers, supports for caregiving and challenges of parenting. Interviews were conducted in English with concurrent translation and analysed using thematic analysis. OUTCOMES AND RESULTS Main themes included: limited finances and social networks shape decisions and caregiving practices; trust in the formal health care system; views of disability including explanations for their infant's condition and expectations for the child's future, and everyday adaptations required to meet infants' needs. CONCLUSIONS AND IMPLICATIONS Low cost models of early intervention may alleviate the financial burden and stress on families. Dependence on health care professionals for care management is a barrier to family-delivered approaches to care.
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Affiliation(s)
- Nataya Branjerdporn
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Australia.
| | - Emma Crawford
- The University of Queensland, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, Australia.
| | - Jenny Ziviani
- The University of Queensland, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, Australia.
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Australia.
| | - Katherine Benfer
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Australia.
| | - Leanne Sakzewski
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Australia.
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Saloojee G, Ekwan F, Andrews C, Damiano DL, Kakooza-Mwesige A, Forssberg H. Akwenda intervention programme for children and youth with cerebral palsy in a low-resource setting in sub-Saharan Africa: protocol for a quasi-randomised controlled study. BMJ Open 2021; 11:e047634. [PMID: 34006038 PMCID: PMC7942240 DOI: 10.1136/bmjopen-2020-047634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood-onset motor disorder accompanied by associated impairments, placing a heavy burden on families and health systems. Most children with CP live in low/middle-income countries with little access to rehabilitation services. This study will evaluate the Akwenda CP programme, a multidimensional intervention designed for low-resource settings and aiming at improving: (1) participation, motor function and daily activities for children with CP; (2) quality of life, stress and knowledge for caregivers; and (3) knowledge and attitudes towards children with CP in the communities. METHODS This quasi-randomised controlled clinical study will recruit children and youth with CP aged 2-23 years in a rural area of Uganda. Children will be allocated to one of two groups with at least 44 children in each group. Groups will be matched for age, sex and motor impairment. The intervention arm will receive a comprehensive, multidimensional programme over a period of 11 months comprising (1) caregiver-led training workshops, (2) therapist-led practical group sessions, (3) provision of technical assistive devices, (4) goal-directed training and (5) community communication and advocacy. The other group will receive usual care. The outcome of the intervention will be assessed before and after the intervention and will be measured at three levels: (1) child, (2) caregiver and (3) community. Standard analysis methods for randomised controlled trial will be used to compare groups. Retention of effects will be examined at 12-month follow-up. ETHICS AND DISSEMINATION The study has been approved by the Uganda National Council for Science and Technology (SS 5173) and registered in accordance with WHO and ICMJE standards. Written informed consent will be obtained from caregivers. Results will be disseminated among participants and stakeholders through public engagement events, scientific reports and conference presentations. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR202011738099314) Pre-results.
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Affiliation(s)
| | - Francis Ekwan
- Department of Occupational Therapy, Mulago National Referral Hospital, Kampala, Uganda
| | - Carin Andrews
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Diane L Damiano
- Department of Rehabilitation Medicine, The National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | | | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Assenza C, Catania H, Antenore C, Gobbetti T, Gentili P, Paolucci S, Morelli D. Continuity of Care During COVID-19 Lockdown: A Survey on Stakeholders' Experience With Telerehabilitation. Front Neurol 2021; 11:617276. [PMID: 33519697 PMCID: PMC7838679 DOI: 10.3389/fneur.2020.617276] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/04/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: To explore professionals', adult patients', and children's caregivers' perception and satisfaction with telerehabilitation during COVID-19 lockdown. Design: An observational transversal study on a web-based survey was conducted in order to explore participants' perception and satisfaction of telerehabilitation during COVID-19 lockdown. Setting: The study was conducted at our Outpatient Neurorehabilitation Service. Subjects: All rehabilitation professionals, adult patients, and children's caregivers who accepted telerehabilitation were recruited. Interventions: Participants had to respond to the Client Satisfaction Questionnaire-8 and to a purpose-built questionnaire on their perception and satisfaction of the service provided. Main Measures: Data were analyzed by qualitative statistics and logistic regression models. Results: All 144 caregivers, 25 adult patients, and 50 professionals reported a medium-high level of perception and a high level of satisfaction. Results showed a correlation among caregivers of children aged 0-3 and feeling overwhelmed with remote care (OR = 3.27), a low perception of telerehabilitation for enhancing goals (OR = 6.51), and a high perception of feeling helped in organizing daily activity (OR = 2.96). For caregivers of children aged over 6 years, changes in the therapy plan were related to a low perception of feeling in line with the in-person therapy (OR = 2.61 and OR = 9.61) and a low satisfaction (OR = 5.54 and OR = 4.97). Changes in therapy were related to concern (OR = 4.20). Caregivers under 40 and professionals showed a high probability to perceive telerehabilitation as supportive (OR = 2.27 and OR = 5.68). Level of experience with remote media was shown to influence perception and satisfaction. Interpretation: Telerehabilitation can be a useful practice both during a health emergency and in addition to in-presence therapy.
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Affiliation(s)
- Carla Assenza
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Hilenia Catania
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Clementina Antenore
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Tiziana Gobbetti
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Paola Gentili
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
| | - Daniela Morelli
- Neurorehabilitation Outpatient Department, Santa Lucia Foundation (Scientific Institute for Research and Health Care), Rome, Italy
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Toldo M, Varishthananda S, Einspieler C, Tripathi N, Singh A, Verma SK, Vishwakarma K, Zhang D, Dwivedi A, Gupta R, Karn S, Kerketta N, Narayan R, Nikam Singh K, Rani S, Singh A, Singh D, Singh KP, Singh N, Singh N, Singh R, Singh SP, Srivastava R, Srivastava S, Srivastava S, Yadav G, Yadav P, Yadav S, Yadav S, Marschik PB. Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme. BMJ Open 2020; 10:e037335. [PMID: 33148727 PMCID: PMC7640505 DOI: 10.1136/bmjopen-2020-037335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Around 9% of India's children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures. METHODS This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants' GMs twice, that is, within 2 months after birth and at 3-5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12-24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12-24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA. ETHICS AND DISSEMINATION G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.
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Affiliation(s)
- Moreno Toldo
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Swami Varishthananda
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Christa Einspieler
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
| | - Neeraj Tripathi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Anshu Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Surendra K Verma
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Kanchan Vishwakarma
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Dajie Zhang
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | - Agyeya Dwivedi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ritika Gupta
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sanjay Karn
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Nirmal Kerketta
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ram Narayan
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | | | - Sumitra Rani
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Akanksha Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Divyanshu Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Krishna Pratap Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Navin Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Neeraj Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Rishi Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Shyam P Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Rakesh Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sandeep Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sanjeev Srivastava
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Gopal Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Preeti Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sheshnath Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sujata Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Peter B Marschik
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
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Smythe T, Matos M, Reis J, Duttine A, Ferrite S, Kuper H. Mothers as facilitators for a parent group intervention for children with Congenital Zika Syndrome: Qualitative findings from a feasibility study in Brazil. PLoS One 2020; 15:e0238850. [PMID: 32913354 PMCID: PMC7482954 DOI: 10.1371/journal.pone.0238850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Zika virus outbreak in Brazil (2015-2016) affected thousands of children who were born with Congenital Zika Syndrome (CZS). Families play an important role in their care of children with complex needs, yet their knowledge, experience and skills are rarely harnessed in existing interventions to best support these families. OBJECTIVE This study explores the use of mothers as facilitators for a community-based group intervention for children with CZS and their caregivers in Brazil. METHODS Four facilitators were trained to deliver the 10-week intervention called "Juntos". Two were mothers of a child with CZS ("expert mothers") and two were therapists (speech therapist and physiotherapist). The intervention was delivered to three groups, generally including 8-10 caregivers. Two researchers, who were psychologists, observed the groups and held focus group discussions at the end of each session. They undertook semi-structured interviews post intervention with a purposive sample of caregivers, and with the facilitators. Observation notes were collated and summarised. Transcripts were transcribed and thematically analysed using five elements to assess feasibility: acceptability, demand, implementation, practicality and adaptation. RESULTS The use of expert mothers as facilitators was considered to be acceptable and there was demand for their role. Their experiential knowledge was viewed as important for sharing and learning, and supporting and encouraging the group. The intervention was delivered with fidelity by the expert mothers. The practicality of the intervention was facilitated by holding the group sessions in the community, providing transport costs to facilitators and participants, paying expert mothers and therapist facilitators equally and supporting the expert mothers through a mentorship programme. Equal payment with the therapist enabled the expert mothers to better facilitate the groups, through increased confidence in the value of their role. Adaptation of the intervention included development of video resources and mentoring guidelines. CONCLUSION The use of expert mothers as facilitators of caregiver groups provides a unique approach to harness the knowledge, experience, and skills of families to provide care, and is likely to be feasible in similar contexts.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Monica Matos
- Collective Health Institute, Universidade Federal da Bahia, Salvador, Brazil
| | - Julia Reis
- Department of Child Psychology, Rehabilitation Institute of Bahia, Salvador, Brazil
| | - Antony Duttine
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Federal University of Bahia, Salvador, Brazil
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
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25
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Kohli-Lynch M, Ponce Hardy V, Bernal Salazar R, Bhopal SS, Brentani A, Cavallera V, Goh E, Hamadani JD, Hughes R, Manji K, Milner KM, Radner J, Sharma S, Silver KL, Lawn JE, Tann CJ. Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation. BMJ Open 2020; 10:e032134. [PMID: 32341042 PMCID: PMC7204990 DOI: 10.1136/bmjopen-2019-032134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. SETTING We evaluated 32 RCEL projects across 17 LMICs on four continents. PARTICIPANTS Overall, 2165 workers delivered ECD interventions to 25 909 families. INTERVENTION Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. PRIMARY AND SECONDARY OUTCOMES We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. RESULTS Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. CONCLUSIONS This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.
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Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Raquel Bernal Salazar
- Economics Department, Universidad de Los Andes, Bogota, Colombia
- Centro de Estudios de Desarrollo Economico (CEDE), Universidad de Los Andes, Bogota, Colombia
| | - Sunil S Bhopal
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle upon Tyne, UK
| | - Alexandra Brentani
- Departamento do Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard Van Leer Foundation, The Hague, Netherlands
| | - Jena D Hamadani
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Rob Hughes
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, United Kingdom
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Social Aspects of Health across the Life Course, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Soloveichick M, Marschik PB, Gover A, Molad M, Kessel I, Einspieler C. Movement Imitation Therapy for Preterm Babies (MIT-PB): a Novel Approach to Improve the Neurodevelopmental Outcome of Infants at High-Risk for Cerebral Palsy. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2019; 32:587-598. [PMID: 32669775 PMCID: PMC7346982 DOI: 10.1007/s10882-019-09707-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To improve the neurodevelopmental outcome in infants with high grade intraventricular haemorrhage and cramped-synchronised (CS) general movements (GMs). Four very preterm infants with intraventricular haemorrhage grade III (n = 3) or intraventricular haemorrhage with apparent periventricular haemorrhagic infarction (n = 1) were diagnosed with CS GMs at 33 to 35 weeks postmenstrual age. A few days later MIT-PB [Movement Imitation Therapy for Preterm Babies], an early intervention programme, was commenced: the instant an infant showed CS movements, the therapist intervened by gently guiding the infant's limbs so as to manoeuvre and smoothen the movements, thereby imitating normal GM sequences as closely as possible (at least for 10 min, 5 times a day, with increasing frequency over a period of 10 to 12 weeks). After a period of consistent CS GMs, the movements improved. At 14 weeks postterm age, the age specific GM pattern, fidgety movements, were normal in three infants, one infant had abnormal fidgety movements. At preschool age, all participants had a normal neurodevelopmental outcome. This report on four cases demonstrates that mimicking normal and variable GM sequences might have a positive cascading effect on neurodevelopment. The results need to be interpreted with caution and replication studies on larger samples are warranted. Nonetheless, this innovative approach may represent a first step into a new intervention strategy.
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Affiliation(s)
- Marina Soloveichick
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Peter B. Marschik
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Ayala Gover
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Molad
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irena Kessel
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
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27
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Kohli-Lynch M, Tann CJ, Ellis ME. Early Intervention for Children at High Risk of Developmental Disability in Low- and Middle-Income Countries: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4449. [PMID: 31766126 PMCID: PMC6888619 DOI: 10.3390/ijerph16224449] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
In low- and middle-income countries (LMICs), while neonatal mortality has fallen, the number of children under five with developmental disability remains unchanged. The first thousand days are a critical window for brain development, when interventions are particularly effective. Early Childhood Interventions (ECI) are supported by scientific, human rights, human capital and programmatic rationales. In high-income countries, it is recommended that ECI for high-risk infants start in the neonatal period, and specialised interventions for children with developmental disabilities as early as three months of age; more data is needed on the timing of ECI in LMICs. Emerging evidence supports community-based ECI which focus on peer support, responsive caregiving and preventing secondary morbidities. A combination of individual home visits and community-based groups are likely the best strategy for the delivery of ECI, but more evidence is needed to form strong recommendations, particularly on the dosage of interventions. More data on content, impact and implementation of ECI in LMICs for high-risk infants are urgently needed. The development of ECI for high-risk groups will build on universal early child development best practice but will likely require tailoring to local contexts.
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Affiliation(s)
- Maya Kohli-Lynch
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK;
- Maternal, Adolescent, Reproductive & Child Health, Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Cally J. Tann
- Maternal, Adolescent, Reproductive & Child Health, Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe P.O.Box 49, Uganda
| | - Matthew E. Ellis
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK;
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Nampijja M, Webb E, Nanyunja C, Sadoo S, Nalugya R, Nyonyintono J, Muhumuza A, Ssekidde M, Katumba K, Magnusson B, Kabugo D, Cowan FM, Martinez-Biarge M, Zuurmond M, Morgan C, Lester D, Seeley J, Tann CJ. Randomised controlled pilot feasibility trial of an early intervention programme for young infants with neurodevelopmental impairment in Uganda: a study protocol. BMJ Open 2019; 9:e032705. [PMID: 31601606 PMCID: PMC6797334 DOI: 10.1136/bmjopen-2019-032705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Early intervention programmes (EIPs) for infants with neurodevelopmental impairment have been poorly studied especially in low-income settings. We aim to evaluate the feasibility and acceptability of a group participatory EIP, the 'ABAaNA EIP', for young children with neurodevelopmental impairment in Uganda. METHODS AND ANALYSIS We will conduct a pilot feasibility, single-blinded, randomised controlled trial comparing the EIP with standard care across two study sites (one urban, one rural) in central Uganda. Eligible infants (n=126, age 6-11 completed months) with neurodevelopmental impairment (defined as a developmental quotient <70 on Griffiths Scales of Mental Development, and, or Hammersmith Infant Neurological Examination score <60) will be recruited and randomised to the intervention or standard care arm. Intervention arm families will receive the 10-modular, peer-facilitated, participatory, community-based programme over 6 months. Recruited families will be followed up at 6 and 12 months after recruitment, and assessors will be blinded to the trial allocation. The primary hypothesis is that the ABAaNA EIP is feasible and acceptable when compared with standard care. Primary outcomes of interest are feasibility (number recruited and randomised at baseline) and acceptability (protocol violation of arm allocation and number of sessions attended) and family and child quality of life. Guided by the study aim, the qualitative data analysis will use a data-led thematic framework approach. The findings will inform scalability and sustainability of the programme. ETHICS AND DISSEMINATION The trial protocol has been approved by the relevant Ugandan and UK ethics committees. Recruited families will give written informed consent and we will follow international codes for ethics and good clinical practice. Dissemination will be through peer-reviewed publications, conference presentations and public engagement. TRIAL REGISTRATION NUMBER ISRCTN44380971; protocol version 3.0, 19th February 2018.
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Affiliation(s)
- Margaret Nampijja
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Emily Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carol Nanyunja
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruth Nalugya
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - James Nyonyintono
- Adara Development, Washington, United Kingdom
- Kiwoko Hospital, Nakaseke, Uganda
| | - Anita Muhumuza
- Neonatal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Kenneth Katumba
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | | | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | | | - Maria Zuurmond
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cathy Morgan
- Cerebral Palsy Alliance Research Institute, Sydney, New South Wales, Australia
- Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Lester
- Adara Development, Washington, United Kingdom
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Janet Seeley
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cally J Tann
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Trust, London, United Kingdom
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El-Sobky TA, El-Sayed M. Situational ethics of study designs for orthopaedic surgery interventions in children with cerebral palsy. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pennington L, Akor WA, Laws K, Goldbart J. Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders. Cochrane Database Syst Rev 2018; 7:CD012507. [PMID: 30040119 PMCID: PMC6513435 DOI: 10.1002/14651858.cd012507.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills. OBJECTIVES To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies. SELECTION CRITERIA We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea.Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias.There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it. AUTHORS' CONCLUSIONS There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Wanwuri A Akor
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Kate Laws
- Northumberland, Tyne and Wear NHS Foundation Trust, Walkergate Park Centre for Neuro‐Rehabilitation and Neuro‐PsychiatryRegional Communication Aid ServiceBenfield RoadNewcastle upon TyneUKNE6 4 QD
| | - Juliet Goldbart
- Manchester Metropolitan UniversityFaculty of Health, Psychology & Social CareBrooks Building, Birley Fields Campus53 Bonsall StreetManchesterUKM15 6GX
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