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1.
Purpose. Adaptive seating systems using sacral pads and kneeblocks are commonly used throughout the UK with children with complex motor disorders to improve their posture and stability in sitting. We sought to evaluate how effective these systems are for a group of children with cerebral palsy.

Method. A six-visit trial was performed to examine whether this combination controls pelvic and hip positioning. Twenty-three children with cerebral palsy aged 7 - 14 years participated (11 females and 12 males). The kneeblocks (active intervention) were removed for a period in the middle of the trial. Force exerted through the kneeblock, pressure exerted on the sacral pad and postural alignment was measured for change.

Results. Statistically significant differences before and after kneeblock removal were found for force at the kneeblock, but no difference was found in pressure at the sacral pad. No statistically significant correlations between force and pressure or posture were found.

Conclusion. The results indicate that seating systems using a sacral pad and kneeblock may not improve overall posture but may improve hip position in children with cerebral palsy.  相似文献   

2.
Purpose. To investigate the effects of a special seating device: Thoracic-lumbar-sacral orthosis with non-rigid SIDO® frame (TLSO-SIDO®) in non-ambulant children with cerebral palsy.

Method. A prospective study with matched pairs (the same subject pre- and post-intervention) was carried out. A comparison of the lateral view of thoracic-lumbar spine X-ray before and after TLSO-SIDO® application was made. The assessment of changes in daily activities, posture was recorded by questionnaires. A total of 47 children with cerebral palsy at a mean age of 53.2 months ± 30.1 SD were involved in the study; 15 (35.71%) of the 42 children showed significant problems in feeding at the beginning of the study period, they were identified as a special subgroup with feeding difficulties.

Results. The mean pre-TLSO-SIDO® thoracic kyphosis was 53.7 ± 16.2 in Cobb angle, while the post-TLSO-SIDO® thoracic kyphosis was 47.2 ± 12.1. The lumbar lordosis was 21.3 ± 13 and in the TLSO-SIDO® 17.8 ± 11.9. The majority of the children have shown improvement in the feeding items and in posture (trunk, head and extremities). The overall satisfaction of the parents with the TLSO-SIDO® was very good, namely 3.972 ± 0.796 on the 5-point analogue scale. We did not find a direct correlation with the improvement in the separate items and the overall satisfaction.

Conclusion. It is extremely difficult to measure the effect of the postural management on the development of children with cerebral palsy. According to the results of the study, regular application of the TLSO-SIDO® in children with spastic cerebral palsy had a beneficial effect on feeding problems and on posture.  相似文献   

3.
Purpose. The aim of this study is to describe responsiveness of the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) in a group of children with cerebral palsy (CP).

Method. The subjects were 55 children with cerebral palsy aged 2 to 7 years (mean 4.6 years). We described the responsiveness of the GMFM and PEDI for all children (n = 55), for children younger than 4 years of age (n = 22) and those older or equal to 4 years (n = 33).

Two frames of references for determining responsiveness were used: change over time and external criterion. Responsiveness was calculated with help of the Effect Size (ES), Standardised Response Mean (SRM) and Spearman rank order correlations of change on both the PEDI and GMFM, with change in motor functioning according to the parents as external criterion.

Results. The PEDI has ES and SRM values higher than 0.8. The GMFM has ES and SRM values higher than 0.5. For all dimensions of the PEDI and for almost all dimensions of the GMFM, the ESs and SRMs of the younger group are higher than those of the older group. The ES and the SRM of the GMFM increase with the complexity of the task. When looking at the correlations of the PEDI and GMFM change scores with the opinion of parents, the results are less unequivocal.

Conclusions. Both the GMFM and the PEDI are responsive for change in motor ability over time in children with CP, the most in children younger than 4 years of age.  相似文献   

4.
Purpose. The present study evaluates gross motor abilities and self perception about the physical abilities of pre-school children with amblyopia, in comparison to their unaffected peers.

Method. Twenty-two children with amblyopia, and 25 children with normal vision, aged 4 - 7, were included in this study. Gross motor abilities were evaluated by the Movement Assessment Battery for Children (MABC). The Pictorial Scale of Perceived Competence and Social Acceptance for Young Children were used to measure physical self perception. Parents completed a questionnaire about everyday situations revolving around the child's balance and posture abilities.

Results. Amblyopic children performed significantly worse than the controls according to the MABC subtests and the parents' questionnaire total score. In the scale of perceived competence evaluation the amblyopic children had lower scores in half of the items as well as in the total mean score, but the differences between the groups were not significant. Among the study group, significant correlations were found between several items in the parents' questionnaire and the children's' mean balance score in MABC.

Conclusions. Amblyopia may negatively impact children's motor abilities as expressed by the objective measures in daily living, while self perception is less affected.  相似文献   

5.
Background. The Canadian Occupational Performance Measure (COPM) is a commonly used outcome measure in rehabilitation. In this study it was adapted for very young children by deleting paid/unpaid work and household management categories and having parents act as proxies to rate child performance and their own satisfaction.

Purpose. To assess the internal consistency reliability, content and construct validity, responsiveness, and impact of half scores (20 not 10-point scale) of the adapted COPM.

Method. Parent proxies of subjects aged 2 - 8 (mean 3.9) years with spastic hemiplegic cerebral palsy (n = 41) participating in a clinical trial. There was a total of 214 occupational performance problems for analysis and an additional 56 which had used half score ratings. Internal consistency reliability and construct validity were evaluated using Cronbach alpha statistic. Proxy views explored content validity. Responsiveness was evaluated using pre-post intervention scores and a comparison with Goal Attainment Scaling scores which were assumed to be a suitable benchmark measure. The effect of half scores was assessed by two-sample t-tests.

Results. The COPM adaptations did not have a negative impact on internal consistency reliability as this was acceptable for performance (0.73) and satisfaction (0.83). The high Cronbach alpha scores indicated good construct validity. Content of occupations and rating approach was considered valid by proxies. Use of half scores did not result in significantly different performance ratings, but mean satisfaction ratings were significantly higher when half scores were used (p = 0.0001). This suggests that half scores may provide more precise proxy satisfaction ratings, but at the cost of rigour as internal consistency with satisfaction half scores was lower (0.63 vs. 0.82). Responsiveness to change in clinical status was demonstrated by significant pre-post scores and moderate correlations with goal attainment scores.

Conclusion. The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.  相似文献   

6.
Purpose. The purpose of this study was to determine the impact of ergonomic and environmental variations on indoor shuttle run (SR) performance in wheelchair sportsmen.

Methods. Eleven experienced male wheelchair sportsmen performed three 25-m SRs in random order with varying turning capacity (TC) and mechanical resistance (MR): condition NN where participants used their sports wheelchair on a tartan surface, condition RN with increased MR, and condition RD with limited TC. Metabolic data were continuously recorded using a portable K4b2 system.

Results. Friedman ANOVA with Wilcoxon a posteriori testing indicated similar VO2peak values in all three tests. SR performance, however, was significantly different across the three test conditions (NN: 536.18 ± 119.09 s; RN: 488.82 ± 119.84 s; RD: 404.91 ± 88.41 s). SR performance contributed for 28% of the explained variance of the measured VO2peak. The addition of TC or MR or both increased the explained variance to 32, 38 and 41%, respectively.

Conclusions. These findings demonstrate a significant impact of variations in floor surface and wheelchair-user interface on SR performance. The findings also suggest that strong reservations have to be made regarding the validity of a SR test, as predictor of VO2peak in a wheelchair user population.  相似文献   

7.
Purpose. To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines.

Method. Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period.

Results. AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking.

Conclusion. The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.  相似文献   

8.
Purpose. To examine the experiences of severely physically disabled young people who use electric powered indoor - outdoor chairs (EPIOCs).

Methods. A priori interview questions examined young people's functioning with EPIOCs, pain and discomfort with EPIOC use and accidents or injuries resulting from EPIOC use. Eighteen young people (13 males and five females) aged 10 - 18 (mean 15) years were interviewed by telephone using a qualitative framework approach. Participants were interviewed 10 - 19 (mean 14.5) months after delivery of the chair. Diagnoses included muscular dystrophy (n = 10), cerebral palsy (n = 5), and 'other' (n = 3).

Results. Many children reported positive functioning following EPIOC use, including increased independence and social activities like wheelchair football. However, EPIOC use was also associated with pain and discomfort, as well as perceived lack of safety, and minor accidents. Most young people and their families were fairly satisfied with the service and provision of their wheelchairs.

Conclusions. The findings suggest that the development of disabled young people may benefit from the use of electric powered indoor/outdoor wheelchairs, although the advantages may come at certain costs to young people's perceived and real safety. Recommendations to powered wheelchair providers include the demonstrated need for additional driving training as these young people mature.  相似文献   

9.
Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 - 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 - 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.  相似文献   

10.
Purpose. To use the University of California Los Angeles Loneliness Scale Version 3 to (a) explore and compare the levels of loneliness experienced between two groups of older adults (aged 40 years and over) with cerebral palsy, a group who use natural speech to communicate and a group who use augmentative and alternative communication (AAC) and (b) to test the reliability of the UCLA Loneliness Scale (Version 3) when used with the older adults with cerebral palsy who use a variety of communication modes.

Method. The UCLA Loneliness Scale (Version 3) was administered twice to two groups of older participants with cerebral palsy. Group 1 consisted of 11 participants who used natural speech and Group 2 consisted of nine participants who used augmentative and alternative communication systems. The scores from the second assessment were used to calculate test retest reliability.

Results. The mean loneliness scores for the two groups indicated that older people with cerebral palsy experience more loneliness than older adults without disability. There was no significant difference between the scores of Groups 1 and 2. The UCLA Loneliness Scale (Version 3) is a reliable tool for use with people who communicate using a variety of communication modes.

Conclusions. The UCLA Loneliness Scale (Version 3) items are pertinent to participants' perceived satisfaction with the quantity and quality of their relationships with others. Policy makers, service providers and the general community have a responsibility to ensure that older people with cerebral palsy are given the support they need to achieve satisfactory relationships and thus facilitate a good quality of life as they age.  相似文献   

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