Cognitive Orientation to daily Occupational Performance to improve occupational performance goals for children with executive function deficits after acquired brain injury

AIM

To determine the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in improving the occupational performance goals of children and young people with executive function deficits after acquired brain injury (ABI) (e.g. etiologies such as stroke, encephalitis, brain tumor, and traumatic brain injury).

METHOD

A replicated single-case experimental study using a randomized multiple baseline design across participants and goals was used. Three clusters of four participants (12 participants, nine males and three females, aged 8-16 years) were included. The intervention consisted of 14 individual CO-OP sessions. Each participant chose four goals; three goals were trained during the intervention sessions and a fourth goal served as the control. The Goal Attainment Scale (GAS) was used as a repeated measure to determine goal achievement while the Canadian Occupational Performance Measure (COPM) was used to identify the perceived goal achievement of children, young people, and their parents.

RESULTS

For 26 of the 35 trained goals, the intervention led to statistically significant improvements in the GAS. Perceived occupational performance and satisfaction improved significantly for the trained goals (30 out of 35 goals for the COPM performance and satisfaction of participants; 26 out 31 goals for the COPM performance of parents; 24 out of 31 goals for the COPM satisfaction of parents) and were maintained at the follow-up. Almost all COPM control goal results were significant, but these changes were not supported by the GAS measures or the statistical analysis.

INTERPRETATION

The generally positive results of this study provide evidence of the benefits of using the CO-OP approach with this population.

Perception of COVID-19 Impact on Canadian Occupational Therapy Curricula: Academic and Fieldwork

Background. Delivery of occupational therapy education programs in Canada faced significant disruptions and adaptations because of the COVID-19 pandemic. Curriculum changes were made rapidly under extreme conditions. Purpose. To document and explore changes to curricula (academic and fieldwork), instructional, and assessment methods implemented by Canadian occupational therapy programs in response to the pandemic and capture their perceived impact on student learning. Method. This convergent mixed method design study employed a cross-sectional descriptive survey followed by a member check focus group. Participant recruitment targeted Canadian occupational therapy university program directors, curriculum chairs, and fieldwork coordinators. Findings. Results highlight curriculum modifications included shifting from in-person to online delivery and re-sequencing or deferring in-person components. Fieldwork placements were similarly affected and included adoption of simulations and telepractice. Implications. The development of interpersonal "soft skills" are perceived as being the most disrupted, but the impact of student learning on actual practice is not yet known.

Traduction franco-canadienne de l’Assessment of Systematic Reviews Revised (AMSTAR 2) : validation transculturelle et fidélité interjuges

Objective: Produce a French-Canadian translation of AMSTAR 2, affirm its content validity, and examine interrater reliability. Methods: Based on Vallerand's methodological approach, we conducted forward and parallel inverse-translations. Subsequently, an expert panel evaluated the translations to create a preliminary experimental French-Canadian version. A second expert panel examined this version and proposed additional modifications. Twenty future health professionals then rated the second experimental version for ambiguity on a scale (from 1 to 7). The principal co-investigators then reviewed the problematic elements and proposed a pre-official version. To ascertain content validity, a final back-translation was conducted resulting in the official version. Four judges evaluated 13 systematic reviews using the official French-Canadian version of AMSTAR 2. The Kappa coefficient was used to evaluate interrater reliability. Results: This rigorous adaptation enabled the development of a Franco-Canadian version of AMSTAR 2. Its application demonstrated low ambiguity (mean 1.15; SD 0.26) as well as good overall interrater reliability (total κ > 0.64) across all items. Conclusion: The French-Canadian version of AMSTAR 2 can now support francophone clinicians, educators, and managers in Canada as they undertake evidence-based practice.

Parents' Experience with the CO-OP Approach: A Consolidation of Three Qualitative Investigations

BACKGROUND.

In the cognitive orientation to daily occupational performance (CO-OP) approach, parent involvement is critical for transferring skills from therapeutic settings to everyday contexts.

PURPOSE.

This study aimed to gain insight into the experience of parents whose children with developmental coordination disorder participated in CO-OP intervention.

METHOD.

This consolidation of three small qualitative studies investigating parents' experience involved an inductive qualitative content analysis of 10 parent interviews and 1 parent focus group.

FINDINGS.

Four overarching themes emerged as depicting parents' experience. Although parents recognized the improvements their children made with the intervention, they also expressed several challenges, such as incorporating CO-OP tasks into daily routines, shifting of parent-child relationship and feeling self-efficacious with the approach.

IMPLICATIONS.

This study highlights that parent observation of intervention sessions is not enough to support parents applying CO-OP at home. Research is needed to understand how to best engage parents in the CO-OP approach.

Transforming waiting pauses into opportunity for physical activity: the “Activate your Wait” project

Physical activity is recognised as a major health determinant, with positive effects on health, environmental sustainability and economy. However, worldwide, 1 in 4 adults, and 3 in 4 adolescents do not currently meet the recommendations for physical activity set by the World Health Organization. Notably, the prevalence of inactivity varies considerably within and between countries, and can be as high as 80% in some adult subpopulations. From the urgent need to implement strategies to fight sedentary behaviour, and considering that physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure, the project “Activate your Wait” was born. The project aim is to transform the waiting pauses during everyday life into opportunities to perform simple stretching and active mobilization exercises. The pilot study was carried out in September 2019 at the Terme S. Egidio, Suio Terme Castelforte (Italy). It was divided in three phases: in the pre-intervention phase a questionnaire evaluated the interest in the project (96 responders); during the intervention phase, lasting three days, examples of simple exercises that people can do by themselves were illustrated and undertaken by about 120 participants; in the post-intervention an evaluation questionnaire was administered (71 responders). The intervention aroused great participation and high approval (97%), and resulted in an increase both in willingness to perform exercises during daily waiting breaks (68% vs 94%) and belief in positive results of physical activity on health (74% vs 96%). In a context where the opportunities for physical activity are decreasing and a sedentary lifestyle has reached a high level, this project represents a contribution to the increase in the awareness of the importance of physical activity and the promotion of the culture of movement in the entire population, with an opportunity of easy accessibility in different contexts of life, at all ages.

Key messages

Physical activity is a major determinant of health, therefore it is fundamental to take all possible opportunities to be active. Waiting pauses are the perfect chance to exercise.

Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality

BACKGROUND

An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality.

MATERIALS AND METHODS

Consecutive subjects undergoing ABI assessment for suspected peripheral artery disease or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy), between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3, and abnormal <0.9 or >1.3. All-cause mortality and CV or cancer mortality and hospitalizations for CV disease were collected from administrative databases up to December 2018.

RESULTS

The study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was 61.6 months (53.4-70.1). All-cause, CV and cancer mortality were higher in patients with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48-2.69), 1.98 (95% CI 1.24-3.17) and 1.85 (95% CI 1.09-3.15). Among subjects with abnormal ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17-2.12), and CV mortality, HR 2.39 (95% CI 1.43-3.99), was higher in those with previous CV events. These latter also had a higher risk of hospitalization for myocardial infarction and stroke: HR 1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10-4.28).

CONCLUSIONS

The co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.

Occupational patterns of families living with a health condition: A scoping review

BACKGROUND

A family's health is sustained by its occupational patterns. While it is commonly accepted that a health condition places extra demands on a family's time or can limit daily occupations, few studies have reported on the occupational patterns of these families.

AIMS/OBJECTIVES

This scoping review provides an overview of the current state of research exploring occupational patterns of families living with a health condition.

MATERIAL AND METHOD

Publications between 2000 and 2018 indexed in CINAHL, PsycInfo, Medline and Scopus databases were searched.

RESULTS

Seventy-seven studies were included in the final content analysis. Findings suggest that families' occupational patterns are more complex than simply the sum of individual and shared occupational patterns, but consist of interconnected relational aspects of occupations, rarely highlighted in studies. Moreover, testimonies tend to be predominantly from the mother's perspectives, thereby limiting the scope of understanding of the interdependent nature of families' occupational patterns.

CONCLUSION

To better understand the complexity and interdependence of families' occupational patterns, future studies should examine multiple perspectives (parents and children) when studying occupations in a family setting. This can be enabled by the use of a variety of data collection methodologies.

Psychometric assessment of the French European Developmental Coordination Disorder Questionnaire (DCDQ-FE)

BACKGROUND

The Developmental Coordination Disorder Questionnaire'07 (DCDQ'07) is a parent-report measure to identify children at risk for Developmental Coordination Disorder (DCD). We developed a French version of the DCDQ'07 (DCDQ-FE) that has shown excellent inter-language reliability (intraclass correlation coefficient (ICC) = 0.91) and is culturally relevant for use in European countries. The aims of this study were to examine the internal consistency, test-retest reliability, construct validity of the Developmental Coordination Disorder Questionnaire-French European (DCDQ-FE), as well as establish a cut-off score.

METHODS

The psychometric properties of the DCDQ-FE were examined with a clinical group of 30 children (mean age: 9.4 years, SD = 2.6) and a control group of 43 children (mean age: 9.1 years, SD = 2.4). Their parents (n = 73) filled out the DCDQ-FE at a first sitting and 70 of them filled it out 38 days later in average for test-retest reliability. The children were assessed using the Movement Assessment Battery for Children-2 (MABC-2) so as to measure the convergent validity of the DCDQ-FE. The cut-off score was determined with an additional sample of 42 children according to scores on the MABC-2 (≥ 16th percentile) (n = 115).

RESULTS AND IMPLICATIONS

Internal consistency of the DCDQ-FE was excellent (Cronbach's alpha = 0.96) and test-retest reliability was good (ICC = 0.956) with no differences between scores obtained at the two sittings (p > 0.05). Differences in scores between children in the clinical and control groups (Z = -6.58, p < 0.001) provide evidence of construct validity. The correlation obtained between DCDQ-FE and MABC-2 scores (Spearman's rho correlation coefficient = 0.802, p < 0.001) supports convergent validity. Using a cut-off of 56, overall sensitivity and specificity were 85.0% and 81.6% respectively (area under the curve = 0.896). The DCDQ-FE is a reliable and valid questionnaire for detecting children who are at risk for DCD in a European-French population of children aged 5 to 15 years old.

Targeting myelin lipid metabolism as a potential therapeutic strategy in a model of CMT1A neuropathy

In patients with Charcot-Marie-Tooth disease 1A (CMT1A), peripheral nerves display aberrant myelination during postnatal development, followed by slowly progressive demyelination and axonal loss during adult life. Here, we show that myelinating Schwann cells in a rat model of CMT1A exhibit a developmental defect that includes reduced transcription of genes required for myelin lipid biosynthesis. Consequently, lipid incorporation into myelin is reduced, leading to an overall distorted stoichiometry of myelin proteins and lipids with ultrastructural changes of the myelin sheath. Substitution of phosphatidylcholine and phosphatidylethanolamine in the diet is sufficient to overcome the myelination deficit of affected Schwann cells in vivo. This treatment rescues the number of myelinated axons in the peripheral nerves of the CMT rats and leads to a marked amelioration of neuropathic symptoms. We propose that lipid supplementation is an easily translatable potential therapeutic approach in CMT1A and possibly other dysmyelinating neuropathies.

Movement imagery as a predictor of online control in typically developing children

The ability to mentally represent actions is suggested to play a role in the online control of movement in healthy adults. Children's movement imagery ability and online control have been shown to develop at similar nonlinear rates. The current study investigated the relationship between movement imagery and online control in children by comparing implicit and explicit movement imagery measures with the ability to make online trajectory corrections. Imagery ability was a significant predictor of children's online control of movement once general reaching efficiency was controlled for. These findings extend the proposed relationship between movement imagery and online control.

Intracellular amorphous carbonates uncover a new biomineralization process in eukaryotes

Until now, descriptions of intracellular biomineralization of amorphous inclusions involving alkaline-earth metal (AEM) carbonates other than calcium have been confined exclusively to cyanobacteria (Couradeau et al., 2012). Here, we report the first evidence of the presence of intracellular amorphous granules of AEM carbonates (calcium, strontium, and barium) in unicellular eukaryotes. These inclusions, which we have named micropearls, show concentric and oscillatory zoning on a nanometric scale. They are widespread in certain eukaryote phytoplankters of Lake Geneva (Switzerland) and represent a previously unknown type of non-skeletal biomineralization, revealing an unexpected pathway in the geochemical cycle of AEMs. We have identified Tetraselmis cf. cordiformis (Chlorophyta, Prasinophyceae) as being responsible for the formation of one micropearl type containing strontium ([Ca,Sr]CO₃ ), which we also found in a cultured strain of Tetraselmis cordiformis. A different flagellated eukaryotic cell forms barium-rich micropearls [(Ca,Ba)CO₃ ]. The strontium and barium concentrations of both micropearl types are extremely high compared with the undersaturated water of Lake Geneva (the Ba/Ca ratio of the micropearls is up to 800,000 times higher than in the water). This can only be explained by a high biological pre-concentration of these elements. The particular characteristics of the micropearls, along with the presence of organic sulfur-containing compounds-associated with and surrounding the micropearls-strongly suggest the existence of a yet-unreported intracellular biomineralization pathway in eukaryotic micro-organisms.

La version franco-canadienne de l'outil Assessment of Multiple Systematic Reviews (AMSTAR)

Objectives: The primary objective was to produce a French-Canadian translation of AMSTAR (a measurement tool to assess systematic reviews) and to examine the validity of the translation's contents. The secondary and tertiary objectives were to assess the inter-rater reliability and factorial construct validity of this French-Canadian version of AMSTAR. Methods: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used.1 First, a parallel back-translation of AMSTAR2 was performed, by both professionals and future professionals. Next, a first committee of experts (P1) examined the translations to create a first draft of the French-Canadian version of the AMSTAR tool. This draft was then evaluated and modified by a second committee of experts (P2). Following that, 18 future professionals (master's students in physiotherapy) rated this second draft of the instrument for clarity using a seven-point scale (1: very clear; 7: very ambiguous). Lastly, the principal co-investigators then reviewed the problematic elements and proposed final changes. Four independent raters used this French-Canadian version of AMSTAR to assess 20 systematic reviews that were published in French after the year 2000. An intraclass correlation coefficient (ICC) and kappa coefficient were calculated to measure the tool's inter-rater reliability. A Cronbach's alpha coefficient was also calculated to measure internal consistency. In addition, factor analysis was used to evaluate construct validity in order to determine the number of dimensions. Results: The statements on the final version of the AMSTAR tool received an average ambiguity rating of between 1.0 and 1.4. No statement received an average rating below 1.4, which indicates a high level of clarity. Inter-rater reliability (n=4) for the instrument's total score was moderate, with an intraclass correlation coefficient of 0.61 (95% confidence interval [CI]: 0.29, 0.97). Inter-rater reliability for 82% of the individual items was good, according to the kappa values obtained. Internal consistency was excellent, with a Cronbach's alpha coefficient of 0.91 (95% CI: 0.83, 0.99). The French-Canadian version of AMSTAR is a unidimensional tool, as confirmed by factor analysis and community values greater than 0.30. Conclusion: A valid French-Canadian version of AMSTAR was created using this rigorous five-step process. This version is unidimensional, with moderate inter-rater reliability for the elements overall, and with excellent internal consistency. This tool could be valuable to French-Canadian professionals and researchers, and could also be of interest to the international Francophone community.

Scoping Review of Self-Regulation: What Are Occupational Therapists Talking About?

Although the term self-regulation is appearing more frequently in the occupational therapy literature, the extent to which it is consistently conceptualized is not clear. The aim of this scoping review was to examine how the term self-regulation is used by occupational therapists in research and practice literature. A total of 58 publications that included occupational therapy and self-regulation in the title, key words, or abstract were identified. Self-regulation was not explicitly defined by more than half of the authors. Four theoretical orientations seem to guide conceptualization: synactive development, sensory integration, cognitive-behavioral theory, and self-regulation theory. Conceptualization differed according to the population, levels of strategy use, source of strategy implementation, and desired outcomes. A lack of definitional clarity and conceptual consistency of the term self-regulation was noted. Use of an explicit definition in relation to an identified theoretical framework is recommended to promote intra- and interprofessional communication, education, and research.

Verbal Self-Guidance as a Treatment Approach for Children with Developmental Coordination Disorder: A Systematic Replication Study

Children with developmental coordination disorder (DCD) experience many occupational performance difficulties in all areas of daily living. For the most part, research has failed to identify an effective treatment approach for these children. Verbal self-guidance (VSG), a new approach, first explored by Wilcox and Polatajko (1993), appears to have good potential in helping children with DCD become competent in the occupations of their choice. The purpose of this study was to carry out a systematic replication of the first VSG study to determine if a different therapist could achieve similar results. Repeating the VSG procedure with four different children, using a single case study design, a different therapist was able to replicate the earlier findings. This provides further evidence of the potential of VSG as an effective approach for enabling children with DCD to surmount their motor challenges.

Exploring inter-task transfer following a CO-OP approach with four children with DCD: A single subject multiple baseline design

INTRODUCTION

Cognitive Orientation to daily Occupational Performance (CO-OP) approach has been shown to be effective for improving the performance of tasks worked on in therapy and the use of cognitive strategies. No study to date seems to have explored its effectiveness for improving performance of untrained tasks (inter-task transfer) in children with Developmental Coordination Disorder (DCD).

OBJECTIVE

This study aimed to determine whether CO-OP leads to improved performance in an untrained task.

METHODS

A single-subject design with multiple baselines across skills was adopted, with three replications. Four children with DCD (7-12years) received 10 sessions of CO-OP intervention where each child worked on three tasks during therapy sessions and a fourth task was identified, but not worked on, to verify inter-task transfer. Task performance was rated over four phases (baseline, intervention, post-intervention, follow-up) using the Performance Quality Rating Scale (PQRS-OD). Graphed data was statistically analyzed using a two or three standard deviation band method.

RESULTS

Significant improvement was obtained for 11 of 12 tasks worked on during therapy and for two of the four untrained tasks.

CONCLUSION

These results indicate that the effectiveness of CO-OP to improve untrained tasks in children merit further exploration.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis

OBJECTIVE

To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA).

DATA SOURCES

An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov.

STUDY SELECTION

The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis.

DATA EXTRACTION

Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations.

DATA SYNTHESIS

All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+).

CONCLUSIONS

The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.

European-French Cross-Cultural Adaptation of the Developmental Coordination Disorder Questionnaire and Pretest in French-Speaking Switzerland

The Developmental Coordination Disorder Questionnaire (DCDQ'07) is a Canadian-English instrument recommended for screening children aged 5 to 15 years who are at risk for developmental coordination disorder. While a Canadian-French version of the DCDQ'07 presently exists, a European-French version does not.

AIMS

To produce a cross-cultural adaptation of the DCDQ'07 for use in areas of Europe where French is spoken and to test its cultural relevance in French-speaking Switzerland.

METHODS

Cross-cultural adaptation was done using established guidelines. Cultural relevance was analyzed with cognitive interviews of thirteen parents of children aged 5.0 to 14.6 years (mean age: 8.5 years, SD = 3.4), using think-aloud and probing techniques.

RESULTS

Cultural and linguistic differences were noted between the European-French, the Canadian-French, and the original versions of the DCDQ'07. Despite correct translation and expert committee review, cognitive interviews revealed that certain items of the European-French version were unclear or misinterpreted and further modifications were needed.

CONCLUSIONS

After rewording items as a result of the outcomes of the cognitive interview, the European-French version of the DCDQ'07 is culturally appropriate for use in French-speaking Switzerland. Further studies are necessary to determine its psychometric properties.

Medical management of patients with peripheral arterial disease

Peripheral arterial disease (PAD) is one of the most frequent manifestations of atherosclerosis and is associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of cardiovascular events. Major risk factors of PAD are similar to those that lead to atherosclerosis in other vascular beds. However, there are differences in the power of individual risk factors in the different vascular territories. Cigarette smoking and diabetes mellitus represent the greatest risks of PAD. For prevention of the progression of PAD and accompanying cardiovascular events similar preventative measures are used as in coronary artery disease (CAD). However, recent data indicate that there are some differences in the efficacy of drugs used in the prevention of atherothrombotic events in PAD. Antiplatelet treatment is indicated in virtually all patients with PAD. In spite of the absence of hard evidence- based data on the long term efficacy of aspirin, it is still considered as a first line treatment and clopidogrel as an effective alternative. The new antiplatelet drugs ticagrelol and prasugrel also represent promising options for treatment of PAD. Statin therapy is indicated to achieve the target low density lipoprotein cholesterol level of ≤2.5 mmol/L (100 mg/dL) and there is emerging evidence that lower levels are more effective. Statins may also improve walking capacity. Antihypertensive treatment is indicated to achieve the goal blood pressure (<140/90 mmHg). All classes of antihypertensive drugs including beta-blockers are acceptable for treatment of hypertension in patients with PAD. Diabetic patients with PAD should reduce their glycosylated haemoglobin to ≤7%. As PAD patients represent the group with the highest risk of atherothrombotic events, these patients need the most intensive treatment and elimination of risk factors of atherosclerosis. These measures should be as comprehensive as those in patients with established coronary and cerebrovascular disease.

Consensus Document on Intermittent Claudication from the Central European Vascular Forum (C.E.V.F.)-3rd revision (2013) with the sharing of the Mediterranean League of Angiology and Vascular Surgery, and the North Africa and Middle East Chapter of International Union of Angiology

This paper is the review of the Consensus Document on Intermittent Claudication of the Central European Vascular Forum (CEVF), published in 2008, and and shared with the North Africa and Middle East Chapter of International Union of Angiology and the Mediterranean League of Angiology and Vascular Surgery. The Document presents suggestions for general practitioners and vascular specialists for more precise and appropriate management of PAD, particularly of intermittent claudication, and underlines the investigations that should be required by GPs and what the GP should expect from the vascular specialist (angiologist, vascular surgeon). The idea of the Faculty is to produce a short document, which is an easy reference in daily clinical practice, both for the GPs and vascular specialists.

Implementing a Modified Cognitive Orientation to Daily Occupational Performance Approach for Use in a Group Format

Cognitive orientation to daily occupational performance is an intervention approach that is often used with children with developmental coordination disorder, and is usually implemented using an individual intervention format.

This practice analysis describes two experiences of the cognitive orientation to daily occupational performance approach, modified for use in a group format: an intensive day-camp, and a weekly after-school club. The group format provided children with various opportunities (for example, helping other children and realizing that different ‘plans’ work for different people) and challenges (for example, maintaining both children's engagement during problem solving and heterogeneity in children's breakdowns). Cognitive orientation to daily occupational performance in a group format is feasible and has the potential to encourage skill acquisition for a greater number of children with developmental coordination disorder.

French Canadian cross-cultural adaptation of the Developmental Coordination Disorder Questionnaire '07: DCDQ-FC

BACKGROUND

Parent-report measures, such as the Developmental Coordination Disorder Questionnaire'07 (DCDQ'07), are used to identify developmental coordination disorder (DCD) in children. Early identification of this condition is important to mitigate its social-emotional and health consequences. Unfortunately, few French-language assessments are available to therapists working with francophone populations.

PURPOSE

The aim of this study was to undertake a formal translation of the English DCDQ'07 and begin to examine its psychometric properties.

METHODS

The translation was done using Beaton, Bombardier, and Guillemin's (2000) guidelines for cross-cultural adaptation. Methodologies described by Haccoun (1987) and Vallerand (1989) were used to address the psychometric qualities of the translation.

FINDINGS

The DCDQ'07 and its French translation (DCDQ-FC) are equivalent, with excellent internal consistency and test-retest reliability. Concurrent and construct validity were adequate for a screening measure; however, low sensitivity was obtained with both measures.

IMPLICATIONS

The DCDQ-FC is a valid translation for use with a French Canadian population.

Floor time play with a child with autism: a single-subject study

BACKGROUND

Children with autism exhibit difficulties with social interaction and communication skills, and they present with restricted interests and stereotyped patterns of behaviour that affect their daily lives. Floor time play (FTP) is an intervention approach that addresses these issues; however, there are few published studies on its effectiveness.

PURPOSE

This study determines the effectiveness of FTP intervention with a child diagnosed with autism.

METHODS

A single subject AB design was used with circles of communication as the behaviour indicator for improvement. Visual and statistical analyses were completed. The child's mother kept a daily journal describing FTP intervention sessions at home.

FINDINGS

Despite variability in the data, statistical analyses indicate a significant difference between the numbers of circles of communication during the intervention phase as compared with the observation phase. Implications. This study provides preliminary evidence for the use of the FTP approach with a child with autism.

Feedforward self-modeling enhances skill acquisition in children learning trampoline skills

The purpose of this research was to examine whether children would benefit from a feedforward self-modeling (FSM) video and to explore possible explanatory mechanisms for the potential benefits, using a self-regulation framework. To this end, children were involved in learning two five-skill trampoline routines. For one of the routines, a FSM video was provided during acquisition, whereas only verbal instructions were provided for the alternate routine. The FSM involved editing video footage such that it showed the learner performing the trampoline routine at a higher skill level than their current capability. Analyses of the data showed that while physical performance benefits were observed for the routine that was learned with the FSM video, no differences were obtained in relation to the self-regulatory measures. Thus, the FSM video enhanced motor skill acquisition, but this could not be explained by changes to the varied self-regulatory processes examined.

Unbalanced risk factors, could compromise the effectiveness of physical training in patients with intermittent claudication?

AIM

The correction of atherosclerotic risk factors is the unavoidable assumption to assure the maximal effectiveness and duration of the results of any therapeutic intervention (pharmacological and surgical) for the treatment of intermittent claudication. Aim of this study has been to verify if the presence/absence of risk factors and the degree of their correction could compromise the responsiveness of claudicant patients to the supervised physical training.

METHODS

Initial (IDC), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. The measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70% of the ACD measured by a non-maximal treadmill exercise. The patients' cohort has been stratified in 7 groups and 18 sub-groups (no smokers, smokers in the past, still smokers, no-diabetics, well balanced and unbalanced diabetes, absent, well balanced and unbalanced hypercholesterolemia, normal weight, over weight and light obesity, hypertensive and no-hypertensive, with and without previous myocardial infarction and TIAs or stroke). The mean and standard error of ICD, ACD and RT before and after 18 days of physical training have been calculated and compared with Student's t test in each group and sub-group. On the data before and after training of ICD, ACD and RT of each group of risk factors the multivariate analysis of the variance has been carried out by analysis of variance (ANOVA). All the analyses were considered significant when the P value was less than 0.05.

RESULTS

ICD values increased from 55.12 to 121.86 m, ACD from 103.16 to 191.58 m, RT reduced from 204.04 to 87.46 s, confirming the relevant (P<0.0001) effectiveness of supervised physical training on the walking capacity of claudicant patients. The comparison between the deltas (value after minus value before) of each sub-group did not show any significant difference. The multivariate ANOVA of before and after ICD ACD and RT of each risk factor groups showed values relevantly lesser than 0.05, indicating that risk factors did not influence the result of physical training.

CONCLUSIONS

The supervised physical training is confirmed as an effective tool for the treatment of claudicant patient. We did not find any significant difference in the response to the programme related with the presence, absence or balance degree of risk factors, and we conclude that physical training effectiveness is independent from the their presence, absence or balance degree. This statement is very important because highlights the physical training as the only therapeutic tool for peripheral arterial disease (PAD) independent from the results of the risk factors' treatment.

Effectiveness and costs of a short-course supervised training program in claudicants: proposal for a shared protocol with aerobic working load

AIM

The purpose of this study was to assess the costs and effectiveness of a short-course physical training program, consisting of an aerobic protocol with clearly defined working loads in each single training session, in patients with intermittent claudication (IC).

METHODS

Initial (ICD), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. Ankle brachial index (ABI) has been measured too. Measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70% of the ACD measured by a non-maximal treadmill exercise.

RESULTS

ICD increased from 56.2 (+/- standard deviation/+/- standard error: 35.3/4.1) to 123.9 (66.5/7.7); ACD increased from 104.8 (49.8/5.8) to 195.1 (81.7/9.5) and RT reduced from 201.2 (98.3/11.4) to 85.8 (43.6/5.1), with P<0.0001 for all parameters. We analyzed separately patients with moderate (M-CL) and severe (S-CL) claudication, and found significant improvements in both groups. The Ds (post-training value minus pretraining value) were: ICD 89.6 (59.9/10.9) in M-CL and 50.2 (29.9/4.6) in S-CL; ACD 102.8 (66.8/11.6) in M-CL and 80.1 (41.5/6.4) in S-CL; RT -98.7 (86.9/15.1) in M-CL and -128.5 (88.1/13.7) in S-CL, with P<0.0001 for all parameters. The differences between M-CL and S-CL were significant only for ICD (P=0.0003) and ACD (P<0.05). ABI showed an increasing trend, which was statistically significant (P<0.001), but clinically irrelevant. The protocol cost was 4179 Euro (average cost 46.30 Euro to walk one additional meter).

CONCLUSION

Supervised physical training is confirmed to be an effective tool for the treatment of IC, and the proposed short-course protocol gave the same improvements as the longer ones while reducing the costs. The proposed procedure for tailoring the working load of a single session identifies clearly the working load, near maximal pain but avoiding the risk of inflammatory activation.

Clonal expansions of pathogenic CD8+ effector cells in the CNS of myelin mutant mice

Tissue damage in the CNS is critically influenced by the adaptive immune system. Primary oligodendrocyte damage (by overexpression of PLP) leads to low-grade inflammation of high pathological impact, which is mediated by CD8+ T cells. To yield further insight into pathogenesis and nature of immune responses in myelin mutated mice, we here apply a detailed immunological characterization of CD8+ T cells in PLP-transgenic and aged wild type mice. We provide evidence that T effector cells accumulate in the CNS of PLP-transgenic and wild-type mice and show a higher level of activation in mutant mice, indicated by surface markers and clonal expansions, as demonstrated by T cell receptor CDR3-spectratype analysis. Vbeta-Jbeta similarities suggest specificity against a common antigen, albeit we could not find specific responses against myelin-antigen-derived peptides. The association of primary oligodendrocyte damage with secondary expansions of pathogenic cells underlines the role of adaptive immune reactions in neurodegenerative and neuroinflammatory diseases.

Circulating levels of cytokines (IL-6 and IL-1beta) in patients with intermittent claudication, at rest, after maximal exercise treadmill test and during restore phase. Could they be progression markers of the disease?

AIM

Inflammation is considered to be one of the main mechanisms for the development and progression of peripheral arterial disease (PAD). Many studies have demonstrated that maximal exercise enhances the acute inflammatory response in claudicant patients, but no one has assessed the duration of this acute inflammatory activation. The aim of this study was to assess of the inflammatory pattern in claudicants and of the inflammatory response after maximal exercise and during the recovery from calf pain.

METHODS

Eleven patients with moderate claudication (MC) (age: 60.5+/-5.8 years; body mass index [BMI]: 27.5+/-4.6; absolute claudication distance [ACD]: 165.4+/-38), 10 patients with severe claudication (SC) (age: 60.3+/-5 years; BMI: 27+/-4.5; ACD: 91+/-11.3) and 8 healthy subjects (age: 59.4+/-6.8; BMI: 28.7+/-4.16) underwent to maximal treadmill test (speed 2.5 km/h, slope 15%). At rest, just after stop of the exercise (appearance of calf pain in patients, and 6 min of treadmill in controls) the circulating levels of interleukin (IL)-1beta and IL-6 have been measured.

STATISTICAL ANALYSIS

variance of mean values, Bonferroni t-test, split plot variance model, variance of d stop-before and stop-recovery have been utilized. P<0.05 has been considered the significant cut-off of the differences.

RESULTS

The maximal exercise excited significant (P<0.01) inflammatory activation in all patients: MC (rest IL-1beta: 1.55, 3.3 at stop; rest IL-6: 5.97, 8.38 at the stop); SC (rest IL-1beta: 2.97, 5.72 at stop; rest IL-6: 6.98, 9.99 at the stop). During recovery, MC showed a reduction of the inflammatory activation, whilst SC showed further increase (IL-1beta: 7.55; IL-6: 11.94).

CONCLUSION

The study confirms the higher inflammatory activation in claudicants and its enhancement after maximal exercise. During recovery, we found two kinds of response: type 1 (controls and MC), in which inflammation subsides, and type 2 (SC) characterized by further inflammatory increase. This trend is not univocal: 3 MC showed a type 2 response and 2 SC showed a type 1. In conclusion, inflammatory activation may depend not only on the degree of endothelial damage, but also on the individual inflammatory attitude, better assessed after maximal exercise than baseline values. This individual inflammatory responsiveness, considering the role of the rest measurement of markers of inflammation recently discussed, could be a useful marker for aggressive PAD.

Acute impairment of the endothelial function by maximal treadmill exercise in patients with intermittent claudication, and its improvement after supervised physical training

AIM

The aim of this study was to determine the effects of maximal exercise and of physical training on endothelial function (EF) of patients with intermittent claudication (IC).

METHODS

EF, assessed by ultrasonography of the brachial artery, has been measured in 22 male patients with IC before (pre-exercise EF) and after (postexercise EF) maximal treadmill test. Absolute claudication distance (ACD) and ankle brachial index (ABI) have been measured too. The measurements have been repeated after 18 days (3 times weekly, for 6 weeks) of supervised physical training.

RESULTS

Before training, the pre-exercise EF was 7.6+/-2.94 and postexercise EF 5.28+/-3.3 (-33.2%) (P<0.01). After training, the pre-exercise EF was 10.3+/-4.04, whilst postexercise EF was 7.79+/-2.56 (-18.97%) (P<0.01). The differences between the pre-exercise value before and after training and between the postexercise value before and after training were significant (P<0.01). ACD and ABI after training increased respectively from 93.95 to 166.55 m and from 0.67 to 0.71 (P<0.001).

CONCLUSIONS

Endothelial dysfunction takes a relevant part in the pathophysiology of IC, with 2/3 of the patients showing an EF lower than the pathological cut-off. Maximal exercise worsens the EF, according to the trend associated with the acute inflammatory response. All these features suggest that physical activity in IC should not utilize the maximal working load, in order to avoid the high inflammatory activation and the acute complications of atherosclerotic plaque. The supervised physical training, besides confirming itself as the most effective means to increase the walking ability, also proved to be able to improve the EF of these patients, as described about other diseases. It is probable that moderate hemodynamic stress reduces the levels of the inflammatory markers and increases the flow-mediated vasodilation through an ischemic preconditioning. The increased walking ability, associated with the improvement of EF could improve the heavy systemic outcome of claudicant patients, as it has been demonstrated in patients with coronary heart disease. Further prospective survival studies on cardiovascular outcomes of trained claudicant patients are needed.

Effects of elastic stocking on quality of life of patients with chronic venous insufficiency. An Italian pilot study on Triveneto Region

AIM

Even though compression therapy is the most recommended treatment for chronic venous insufficiency (CVI) in the national and international guidelines, its application, at least in Italy, is lower than the estimated need from the prevalence of CVI in the epidemiological studies. Since we believe that the measurement of the impact of compression therapy on quality of life (QoL) could improve the compliance for this precious treatment, we carried out this study on 50 patients with CVI.

METHODS

Fifty patients (23 CEAP C2 and 27 C(3-4-5), selected within a larger study on QoL in CVI), received a prescription for compression therapy. Before treatment and 4 months afterwards, the patients received the instrument for QoL assessment (MOS SF-36; CIVIQ-2; Euro-QoL 5D and a visual analogue scale). The score scales have been adjusted to poorest QoL as 0 and best QoL as 100.

RESULTS

Baseline QoL of patients in class C2 did not show significant difference with the healthy Italian Population, except for the physical role item. The patients in class C(3-4-5) showed significant reduction of QoL. After 4 months all the items of the utilized instrument showed significant improvement (from P<0.01 to P<0.04 for SF-36; from P<0.099 to P<0.006 for other instruments) in all CEAP classes.

CONCLUSIONS

The study unquestionably shows that the compression therapy improves the QoL of patients with CVI, and should be included in the CVI treatment covered by the Public National Health Insurance. Finally, the QoL measurement could be utilized as the scientific method to assess the effectiveness and efficacy of different therapeutic devices.