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Byiers BJ, Merbler AM, Burkitt CC, Beisang A, Symons FJ. Preliminary assessment of the reliability and validity of infrared skin temperature measurements in Rett syndrome. J Intellect Disabil Res 2023; 67:387-395. [PMID: 36744445 PMCID: PMC10251747 DOI: 10.1111/jir.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND As clinical trials for Rett syndrome are underway, there is a need to validate potential supplemental outcome measures that reflect important signs and symptoms. Autonomic dysfunction, particularly vasomotor dysfunction, is one potential area for which biomarkers could be developed. METHODS In the current study, infrared thermal images of hands and feet from 26 females with Rett syndrome (aged 62 months to 39 years), and 17 females without known intellectual, genetic or neurological disorders (aged 55 months to 39 years) were collected. Between-group differences in skin temperature, and temporal stability of skin temperature measures in the Rett syndrome group, and relationships between skin temperature measures and parent-reported and researcher-evaluated indicators of autonomic dysfunction were evaluated. RESULTS Between-group differences showed lower hand and foot temperatures in the Rett syndrome group. Hand temperature measurements were stable over time and were moderately correlated with parent-reported autonomic symptoms. Foot temperature measurements were more variable than hand temperatures but showed stronger correlations with parent-reported autonomic symptoms. CONCLUSIONS The results provide preliminary support for the reliability and validity of hand and foot skin temperature measures in Rett syndrome. Additional research is needed to replicate these results and evaluate the temporal stability of these measures over shorter time scales.
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Affiliation(s)
- B J Byiers
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - A M Merbler
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - C C Burkitt
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
| | - A Beisang
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
| | - F J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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Symons FJ, Burkitt CC, Wilcox G, McAdams B, Crabb GW, Kennedy WR. Modifying quantitative sensory testing to investigate behavioral reactivity in a pediatric global developmental delay sample: Relation to peripheral innervation and chronic pain outcomes. Dev Psychobiol 2022; 64:e22329. [PMID: 36426784 PMCID: PMC9708098 DOI: 10.1002/dev.22329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Early tactile and nociceptive (pain) mechanisms in children with global developmental delay at risk for intellectual and developmental disability are not well understood. Sixteen children with global developmental delay (mean age = 5.1 years, SD = 1.4; 50% male) completed a modified quantitative sensory testing (mQST) protocol, an epidermal (skin) punch biopsy procedure, and parent-endorsed measures of pain. Children with reported chronic pain had significantly greater epidermal nerve fiber density (ENFd) compared to children without chronic pain. Based on the mQST trials, ENFd values were associated with increased vocal reactivity overall and specifically during the light touch and cool thermal stimulus trials. The findings support the feasibility of an integrative biobehavioral approach to test nociceptive and tactile peripheral innervation and behavioral reactivity during a standardized sensory test in a high-risk sample for which there is often sensory dysfunction and adaptive behavior impairments.
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Affiliation(s)
- Frank J. Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
| | - Chantel C. Burkitt
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN
- Gillette Children’s Specialty Healthcare, Saint Paul, MN
| | - George Wilcox
- Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Brian McAdams
- Department of Dermatology, University of Minnesota, Minneapolis, MN
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Burkitt CC, Genik LM. Special issue on pain and intellectual and developmental disabilities. Paediatric and Neonatal Pain 2022; 4:1-2. [PMID: 35546917 PMCID: PMC8975184 DOI: 10.1002/pne2.12077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Chantel C. Burkitt
- Gillette Children's Specialty HealthcareSaint PaulMinnesotaUSA
- Department of Educational PsychologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Lara M. Genik
- University of GuelphGuelphOntarioCanada
- Vanier Children's Mental WellnessLondonOntarioCanada
- Archways Centre for CBTLondonOntarioCanada
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Boyer ER, Novaczyk ZB, Novacheck TF, Symons FJ, Burkitt CC. Presence and predictors of pain after orthopedic surgery and associated orthopedic outcomes in children with cerebral palsy. Paediatric and Neonatal Pain 2022; 4:44-52. [PMID: 35546914 PMCID: PMC8975226 DOI: 10.1002/pne2.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/28/2021] [Accepted: 12/05/2021] [Indexed: 12/29/2022]
Abstract
While children with cerebral palsy (CP) may undergo 8‐22 orthopedic surgeries in their lifetime, little is known about the associated pain. We aimed to assess the pain presence before and one year after lower extremity orthopedic surgery, predictors of pain presence at follow‐up, and the association between pain and orthopedic outcomes related to surgery. This retrospective study included 86 children with CP (M age = 10.0 years, SD = 3.2; range = 4.1‐17.3 years, Gross Motor Functional Classification System (GMFCS) level I‐III) who underwent orthopedic surgery and had completed questionnaires at gait analyses before (M = 2.7 months; range = 0.0‐5.7) and after surgery (M = 11.8 months; range = 9.0‐14.9). Pain presence, location, and Pediatric Outcomes Data Collection Instrument (PODCI) scores were documented before and after surgery at gait analyses. Pain prevalence was 60% at baseline and 56% at follow‐up. Significant predictors of pain presence at follow‐up included (1) pain presence at baseline (range of odds ratios [OR] across any/all locations = 3.22 to 15.54), (2) older age (range of OR for any pain, back, knee, and foot pain = 1.24‐1.26), (3) female sex (decreased OR for males for ankle pain = 0.12), (4) having hip surgery (decreased OR for foot pain = 0.20), and (5) lower GMFCS level (OR for foot pain = 0.41). Changes in PODCI Sports and Physical Function scores were associated with changes in hip and knee pain (P < .03); PODCI scores worsened for patients who had pain at both time points and improved for patients who had pain at baseline but not follow‐up. Pain was present for over half of the participants before and after orthopedic surgery. Pain presence at follow‐up was predicted by pain presence at baseline. Pain and functional outcomes were correlated at follow‐up. Prospective studies examining perioperative pain experience and factors predicting pain outcomes are warranted.
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Affiliation(s)
- Elizabeth R. Boyer
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | | | - Tom F. Novacheck
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Orthopedic Surgery University of Minnesota Minneapolis MN USA
| | - Frank J. Symons
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
| | - Chantel C. Burkitt
- Gillette Children’s Specialty Healthcare St. Paul MN USA
- Department of Educational Psychology University of Minnesota Minneapolis MN USA
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Byiers BJ, Roberts CL, Burkitt CC, Merbler AM, Craig KD, Symons FJ. Parental Pain Catastrophizing, Communication Ability, and Post-surgical Pain Outcomes Following Intrathecal Baclofen Implant Surgery for Patients With Cerebral Palsy. Front Pain Res 2022; 2:809351. [PMID: 35295472 PMCID: PMC8915662 DOI: 10.3389/fpain.2021.809351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
There is strong evidence that psychosocial variables, including pain catastrophizing, influence parental and child ratings of pain, pain expression, and long-term outcomes among children with chronic pain. The role of these factors among children who have communication deficits due to cerebral palsy (CP) and other intellectual and developmental disabilities is currently unclear. In this study, parental pain catastrophizing was assessed before intrathecal baclofen (ITB) pump implantation for spasticity management in 40 children and adolescents with CP, aged 4 to 24 years. Pain was assessed before and after surgery with two methods: a parent-reported pain interference scale, and behavioral pain signs during a standardized range of motion exam. Linear mixed models with clinical/demographic factors and scores from the Pain Catastrophizing Scale for Parents (PCS-P), and child spoken language ability as predictors and the pain variables as the outcomes were implemented. On average, both pain outcomes improved after surgery. Only child spoken language ability predicted change in behavioral reactivity scores, with children with phrase speech showing an increase in reactivity at follow-up compared to pre-surgery levels, on average. A significant interaction between PCS-P scores and spoken language ability on change in pain interference scores over time showed that dyads with children with phrase speech whose parents reported high PCS-P scores reported the least improvement in pain interference at follow-up. Due to the preliminary nature of the study, future work is needed to investigate the parental behaviors that mediate the relationships between parental catastrophizing and pain outcomes in this population.
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Affiliation(s)
- Breanne J. Byiers
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Breanne J. Byiers
| | - Caroline L. Roberts
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Chantel C. Burkitt
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
- Gillette Children's Specialty Healthcare, Saint Paul, MN, United States
| | - Alyssa M. Merbler
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Kenneth D. Craig
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Frank J. Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, United States
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Goracke-Postle CJ, Burkitt CC, Panoskaltsis-Mortari A, Ehrhardt M, Wilcox GL, Graupman P, Partington M, Symons FJ. Expression of and correlational patterns among neuroinflammatory, neuropeptide, and neuroendocrine molecules from cerebrospinal fluid in cerebral palsy. BMC Neurol 2021; 21:384. [PMID: 34607558 PMCID: PMC8489087 DOI: 10.1186/s12883-021-02333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background The underlying pathogenesis of cerebral palsy (CP) remains poorly understood. The possibility of an early inflammatory response after acute insult is of increasing interest. Patterns of inflammatory and related biomarkers are emerging as potential early diagnostic markers for understanding the etiologic diversity of CP. Their presence has been investigated in plasma and umbilical cord blood but not in cerebrospinal fluid (CSF). Methods A clinical CP sample was recruited using a single-time point cross-sectional design to collect CSF at point-of-care during a standard-of-care surgical procedure (intrathecal pump implant). Patient demographic and clinical characteristics were sourced from medical chart audit. Results Significant (p ≤ 0.001) associations were found among neuroinflammatory, neuroendocrine, and nociceptive analytes with association patterns varying by birth status (term, preterm, extremely preterm). When between birth-group correlations were compared directly, there was a significant difference between preterm and extremely preterm birth subgroups for the correlation between tumour necrosis factor alpha (TNFα) and substance P. Conclusion This investigation shows that CSF can be used to study proteins in CP patients. Differences in inter-correlational patterns among analytes varying by birth status underscores the importance of considering birth status in relation to possible mechanistic differences as indicated by biomarker signatures. Future work should be oriented toward prognostic and predictive validity to continue to parse the heterogeneity of CP’s presentation, pathophysiology, and response to treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02333-2.
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Affiliation(s)
| | - Chantel C Burkitt
- Gillette Children's Specialty Healthcare, Saint Paul, MN, 55101, USA
| | | | - Michael Ehrhardt
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - George L Wilcox
- Departments of Neuroscience, Pharmacology, Dermatology, University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Patrick Graupman
- Gillette Children's Specialty Healthcare, Saint Paul, MN, 55101, USA
| | | | - Frank J Symons
- Department of Educational Psychology, College of Education and Human Development, Minneapolis, MN, 55455, USA.
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Abstract
Objective To investigate types and intensity of pain experienced by individuals with cerebral palsy (CP) and common pain-relieving approaches used by caregivers. Design The approach was cross-sectional, using standardized interviews. Setting Individuals with CP were recruited from a specialty health care hospital. Participants Eighty-six individuals (N=86; mean age, 17.2 years; male, 58%) with CP and complex communication needs participated. Interventions Not applicable. Main Outcome Measures Pain type, mean pain intensity (MPI) (graded on a scale of 0=no pain to 10=worst possible pain), and mean pain relief (MPR) (graded on a scale of 0=intervention did not help at all to 10=intervention completely relieved pain) were assessed by caregiver report as part of the Dalhousie Pain Interview for each type of pain experienced in the previous 7 days. Results Caregivers reported that 58 participants (67%) had experienced pain in the previous 7 days. MPI was 7.7±1.8 when the pain was worst in the previous 7 days. The 2 most common types of pain included musculoskeletal pain (n=70) and gastrointestinal pain (n=11). The most frequent treatment to relieve musculoskeletal pain was changing positions (n=27, MPI=5.1±2.3, MPR=6.6±2.1), medication (n=25, MPI=7.4±1.6, MPR=5.3±1.9), and massage (n=19, MPI=6.7±1.9, MPR=5.2±1.7). To treat gastrointestinal pain, medication was typically used (n=4, MPI=4.8±1.4, MPR=5.5±1.0), although no treatment was just as common (n=4, MPI=4.5±2.3). Conclusions The results indicate that musculoskeletal pain is prevalent in individuals with CP, and changing physical positions and providing medication are strategies most used by caregivers.
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Affiliation(s)
| | - Chantel C Burkitt
- Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,University of Minnesota, Educational Psychology Department, Minneapolis, Minnesota
| | - Alyssa Merbler
- University of Minnesota, Educational Psychology Department, Minneapolis, Minnesota
| | - Lisa Lykken
- Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Frank J Symons
- University of Minnesota, Educational Psychology Department, Minneapolis, Minnesota
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Burkitt CC, Breau LM, Zabalia M. Parental assessment of pain coping in individuals with intellectual and developmental disabilities. Res Dev Disabil 2011; 32:1564-1571. [PMID: 21377323 DOI: 10.1016/j.ridd.2011.01.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 05/30/2023]
Abstract
Pain coping is thought to be the most significant behavioural contribution to the adjustment to pain. Little is known about how those with intellectual and developmental disabilities (IDD) cope with pain. We describe parental reported coping styles and how coping relates to individual factors. Seventy-seven caregivers of children and adults with IDD reported on coping styles using the Pediatric Pain Coping Inventory (PPCI), pain behaviour using the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), illness-related interactions using the Illness Behaviour Encouragement Scale (IBES) and past pain experience using the Structured Pain Questionnaire. Scores were compared across mental ages and interactions between pain coping and the other factors were explored. A Multivariate Analysis of Variance (MANOVA) by mental age group ('≤4 years', '5-11 years' and '≥12 years') revealed that those in the '5-11 years' mental age group used more coping styles than those in the '≤4 years' mental age group, and those in the '≥12 years' group used more cognitively demanding coping styles than the other two groups (F(10,130)=2.68, p=.005). Seeking Social Support (r=.39, p=.001) and Catastrophizing/Helplessness (r=.33, p<.01) coping styles were significantly related to a greater display of pain behaviour. Those with younger mental ages, who Seek Social Support or Catastrophize, also displayed more pain behaviour, which may be an attempt to seek external resources when pain is beyond their ability to deal with independently.
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Affiliation(s)
- Chantel C Burkitt
- Department of Psychology, Saint Mary's University, 925 Robie Street, Halifax, Nova Scotia, Canada B3H 3C3.
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