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Goodwin J, Lecouturier J, Crombie S, Smith J, Basu A, Colver A, Kolehmainen N, Parr JR, Howel D, McColl E, Roberts A, Miller K, Cadwgan J. Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy. Child Care Health Dev 2018; 44:203-211. [PMID: 29168216 DOI: 10.1111/cch.12540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Although the rationale for standing frame use and the associated challenges have been described, little attention has been given to the users' experiences. The aim of the current study was to explore young people's positive and negative experiences, and attitudes regarding standing frame use. METHODS Framework analysis informed an open exploration of young people's opinions of standing frames. Using semistructured interviews, 12 young people with cerebral palsy (6 female) were interviewed, providing the data set for transcription and thematic analysis. FINDINGS The first theme "attitudes to standing frames" describes the young people's understanding of why they use standing frames. Although standing frames can be painful, some young people believe they should be endured to improve their body structure and function. There were mixed views about the impact standing frames have socially, with some young people feeling excluded from their peers, and others feeling as though standing frames helped them "fit in." Some young people are not offered a choice about how and when they use their standing frame. The second theme "challenges of standing frame use" highlights the issues with standing frame use such as manual handling, interference from siblings, and the lack of aesthetically pleasing standing frame designs. CONCLUSIONS Young people report benefits related to choice, pain relief, and participation but can also cause pain, discomfort, and reduced independence and participation. Healthcare professionals should have open, informative conversations about potential benefits and challenges of standing frames on all aspects of the young people's lives, including participation and activity.
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Affiliation(s)
- J Goodwin
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J Lecouturier
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - S Crombie
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Brighton, UK
| | - J Smith
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Basu
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Colver
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - N Kolehmainen
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J R Parr
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Howel
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - E McColl
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - K Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - J Cadwgan
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust (Kings Health Partners), London, UK
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Goodwin J, Colver A, Basu A, Crombie S, Howel D, Parr JR, McColl E, Kolehmainen N, Roberts A, Lecouturier J, Smith J, Miller K, Cadwgan J. Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy. Child Care Health Dev 2018; 44:195-202. [PMID: 28809057 PMCID: PMC5811781 DOI: 10.1111/cch.12505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use. METHOD Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co-applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK. RESULTS Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child-reported pain. CONCLUSIONS These survey findings provide information from key stakeholders regarding current UK standing frame practice.
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Affiliation(s)
- J. Goodwin
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Colver
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Basu
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Crombie
- Sussex Community NHS Foundation TrustChailey Clinical ServicesBrightonUK
| | - D. Howel
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. R. Parr
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - E. McColl
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - N. Kolehmainen
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Lecouturier
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. Smith
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - K. Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Cadwgan
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Evelina London Children's HospitalGuys and St Thomas' NHS Foundation Trust (Kings Health Partners) UKLondonUK
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Wyrwoll C, Keith M, Noble J, Stevenson PL, Bombail V, Crombie S, Evans LC, Bailey MA, Wood E, Seckl JR, Holmes MC. Fetal brain 11β-hydroxysteroid dehydrogenase type 2 selectively determines programming of adult depressive-like behaviors and cognitive function, but not anxiety behaviors in male mice. Psychoneuroendocrinology 2015; 59:59-70. [PMID: 26036451 PMCID: PMC4510145 DOI: 10.1016/j.psyneuen.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 10/26/2022]
Abstract
Stress or elevated glucocorticoids during sensitive windows of fetal development increase the risk of neuropsychiatric disorders in adult rodents and humans, a phenomenon known as glucocorticoid programming. 11β-Hydroxysteroid dehydrogenase type 2 (11β-HSD2), which catalyses rapid inactivation of glucocorticoids in the placenta, controls access of maternal glucocorticoids to the fetal compartment, placing it in a key position to modulate glucocorticoid programming of behavior. However, the importance of the high expression of 11β-HSD2 within the midgestational fetal brain is unknown. To examine this, a brain-specific knockout of 11β-HSD2 (HSD2BKO) was generated and compared to wild-type littermates. HSD2BKO have markedly diminished fetal brain 11β-HSD2, but intact fetal body and placental 11β-HSD2 and normal fetal and placental growth. Despite normal fetal plasma corticosterone, HSD2BKO exhibit elevated fetal brain corticosterone levels at midgestation. As adults, HSD2BKO show depressive-like behavior and have cognitive impairments. However, unlike complete feto-placental deficiency, HSD2BKO show no anxiety-like behavioral deficits. The clear mechanistic separation of the programmed components of depression and cognition from anxiety implies distinct mechanisms of pathogenesis, affording potential opportunities for stratified interventions.
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Affiliation(s)
- Caitlin Wyrwoll
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom,School of Anatomy, Physiology & Human Biology, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Marianne Keith
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - June Noble
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Paula L. Stevenson
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Vincent Bombail
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Sandra Crombie
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Louise C. Evans
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Matthew A. Bailey
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Emma Wood
- Centre for Cognitive and Neural Systems, University of Edinburgh, EH8 9JZ, United Kingdom
| | - Jonathan R. Seckl
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom
| | - Megan C. Holmes
- UoE/BHF Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, United Kingdom,Corresponding author at: Centre for Cardiovascular Science, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom. Tel.: +44 131 242 6737.
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