Actual vs. best practices for young children with cerebral palsy: A survey of paediatric occupational therapists and physical therapists in Quebec,Canada

Rationale: Cerebral palsy (CP) constitutes a substantial portion of paediatric rehabilitation, yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. This study describes OT and PT practices for young children with CP in Quebec, Canada.

Methods: This was a cross-sectional survey. All eligible, consenting paediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points—18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability and Health (ICF).

Results: 91.9% of PTs (n?=?62; 83.8% participation rate) and 67.1% of OTs (n?=?85; 91.4% participation rate) reported using at least one standardized paediatric assessment. OT and PT interventions focused primarily on impairments and primary function (such as gait function and activities of daily living). Both professions gave little attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice.

Conclusion: Wide variations and gaps were identified in clinicians’ responses suggesting the need for a basic standard of OT and PT management as well as strategies to encourage knowledge dissemination regarding current best practice.

Fundamento: La parálisis cerebral (PC) constituye una parte sustancial de la rehabilitación pediátrica, sin embargo se sabe poco acerca del ejercicio actual de la terapia física (TF) y de la terapia ocupacional (TO). Este estudio describe la aplicación de la TF y de la TO a niños pequeños con PC en Quebec, Canadá. Métodos: Este fue un estudio prospectivo, de corte transversal. Todos los terapistas físicos (TF) y los terapistas ocupacionales (TO) pediátricos elegibles, previo consentimiento, fueron entrevistados utilizando un cuestionario telefónico estructurado basado en viñetas de dos niños típicos con PC a dos edades - 18 meses y 4 años de edad. Las prácticas reportadas fueron agrupadas en base a la Clasificación Internacional de Funcionalidad, discapacidad y salud (CIF). Resultados: 91.9% de los TFs (n?=?62; 83.8% rango de participación) y 67.1% de los TOs (n?=?85; 91.4% rango de participación) reportaron usar por lo menos una forma de evaluación pediátrica estandarizada. Las intervenciones de TF y TO se enfocaron principalmente en las discapacidades y en las funciones primarias (tales como la marcha y las actividades de la vida diaria). Ambas profesiones prestaron poca atención a las intervenciones relacionadas al juego y a las actividades recreativas y de entretenimiento. Los médicos manifestaron la necesidad de un mayor entrenamiento y educación específicos a la PC y la aplicación de los hallazgos de las investigaciones en la práctica clínica. Conclusión: Se identificaron amplias variaciones y un desconocimiento en las respuestas de los médicos, sugiriendo esto la necesidad de un manejo estándar básico de TF y TO, así como estrategias que impulsen la diseminación del conocimiento en relación a una mejor práctica. Palabras clave: Terapia ocupacional, terapia física, parálisis infantil, Clasificación Internacional de Funcionalidad, tratamiento basado en la evidencia, rehabilitación pediátrica     

A molecular and cellular model to explain the differences in reactivation from latency by herpes simplex and varicella–zoster viruses

There are marked similarities in the biological properties of the human neurotropic herpesviruses herpes simplex virus type 1 (HSV–1) and varicella–zoster virus (VZV), including their ability to establish lifelong latent infections in human peripheral sensory ganglia (PSG). Despite this, their patterns of reactivation are quite different: HSV–1 reactivations occur many times during a lifetime, they are localized to the cutaneous distribution of a single sensory nerve, they are not associated with sensory symptomatology and their frequency decreases with age. VZV recurrence on the other hand is usually a single event which tends to appear with advancing age, its cutaneous eruption involves an entire dermatome and is usually extremely painful. To help explain these differences, we have formulated a model based on current knowledge of the molecular and cellular basis of latent infection in the nervous system. We suggest that the amount of latent viral DNA and RNA in the latently infected tissue (higher with HSV–1), the cellular location of latent virus (neuronal in HSV–1, probably non–neuronal in VZV), the presence or absence of viral replication in the PSG during reactivation together with the host immune response, are all key determinants of the clinical expression of viral reactivation.     

Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research.

Physical therapy is often prescribed in Parkinson's disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence-based literature review. The results were supplemented with clinical expertise and patient values and translated into practice recommendations, developed according to international standards for guideline development. A systematic literature search yielded 6 systematic reviews and 23 randomized controlled trials of moderate methodological quality with sufficient data. Six specific core areas for physical therapy were identified: transfers, posture, reaching and grasping, balance, gait, and physical capacity. We extracted four specific treatment recommendations that were based on evidence from more than two controlled trials: cueing strategies to improve gait; cognitive movement strategies to improve transfers; exercises to improve balance; and training of joint mobility and muscle power to improve physical capacity. These practice recommendations provide a basis for current physical therapy in Parkinson's disease in everyday clinical practice, as well as for future research in this field.     

Limitations in daily activities and general perception of quality of life: Long term follow‐up in patients with anti‐myelin‐glycoprotein antibody polyneuropathy

In this study, we assessed the modifications over time of daily activities and quality of life (QoL) in 32 subjects with anti‐myelin‐glycoprotein (MAG) antibody neuropathy. A widespread panel including clinical scores and patient‐reported questionnaires, in compliance of the terms by the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO), was employed at enrollment (T0) and at follow‐up evaluation (T1) after a mean interval of 15.4 ± 5.7 months. The Sensory Modality Sum score (SMS) at four limbs showed a significant worsening over time (mean score 27.2 ± 3.9 at T0 vs 25.7 ± 3 at T1 at upper limbs, P = .03; 20.5 ± 4.8 at T0 vs 18.6 ± 5.9 at T1 at lower limbs, P = .04). The Visual Analogue Scale (VAS) for pain significantly worsened at upper limbs at T1 (mean values 0.84 ± 1.95 at T0 vs 1.78 ± 2.6 at T1, P = .03). All the other tests did not show significant differences between T0 and T1. In the subgroup who underwent rituximab (15/32 treated before T0, 3/32 patients treated between T0 and T1 with median interval of 1 year), no significant differences were observed between T0 and T1. Despite the quite long follow‐up, statistical significance was not achieved either for the limited number of patients or for the lack of sensitive outcome measures. In our cohort, the significant worsening of the SMS and VAS after a median of 14 months can be considered as a reliable expression of the natural history of the disease, and suggest that these scales might represent possible outcome measures in anti‐MAG antibody neuropathy.     

Assessment of patients with intellectual disability using the International Classification of Functioning, Disability and Health to evaluate dental treatment tolerability

Background Patients with serious intellectual disability (ID) are occasionally unable to tolerate dental treatment when intravenous sedation or general anaesthesia (IVS/GA) is involved. In order to make a decision regarding the application of IVS/GA, the International Classification of Functioning, Disability and Health (ICF) is useful. Therefore, in this study, a set of codes involved in dental problems were chosen from the ICF, and patients with ID who could tolerate dental treatments were compared with those who could not. Methods From preliminary interviews of six patients with ID, 16 codes were chosen, and an objective five-rank scale was then constructed for use with all chosen codes. Forty-nine ID patients who visited the Okayama University Hospital for dental treatment between January and April 2003 were evaluated. Facility workers were interviewed according to the code set chosen. The participants were then divided into two subgroups depending on their tolerability of dental treatment. The results of these groups for all 16 codes were then compared. Results Of the 49 patients interviewed, 23 were able to tolerate the dental treatment. In the ‘Activities & Participation’ section of the ICF, the tolerable group showed lower disability levels with regard to d110 Watching, d540 Dressing and d550 Eating. In other sections, there were no significant differences between the groups. The code set chosen in this study and the five-rank scales in each code were useful as they enabled easy interviewing. Conclusions The ICF was raised as a possibility for considering the application of IVS/GA for dental treatment on patients with ID. For clinical use of the ICF, it is recommended that significant codes should be selected and that the five-rank scale is used so that more objective results are obtained from interviews.     

Developing core sets for persons with bipolar disorder based on the International Classification of Functioning, Disability and Health

INTRODUCTION: Functioning is increasingly being taken into account when assessing the impact of bipolar disorder (BD) on the individual, as well as the effectiveness of treatments. With the International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally agreed-upon framework and system for classifying the typical spectrum of problems in functioning, given the environmental context in which subjects live. ICF Core Sets are subgroups of ICF items selected to capture those aspects of functioning that are most likely to be affected by specific disorders. Within a given disorder, both Brief and Comprehensive Core Sets can be established to serve specific purposes. OBJECTIVE: The aim of this paper is to outline the development process of the ICF Core Sets for BD. METHODS: The final definition of ICF Core Sets for BD will be determined at an ICF Core-Sets Consensus Conference, which will integrate evidence from preliminary studies, namely (a) semi-structured interviews with people with BD in different countries, (b) a Delphi exercise with international experts participating and (c) a cross-sectional study. CONCLUSION: ICF Core Sets are being designed with the goal of providing useful standards for research, clinical practice and teaching. We believe that these ICF Core Sets for BD will stimulate research leading to improved understanding of functioning, disability and health in BD. Such research, we hope, will lead to interventions and accommodations to improve restoration and maintenance of functioning and minimise disability among people with BD throughout the world.     

Relative Frequency of Different Types of Epilepsy: A Study Employing the Classification of the International League Against Epilepsy

Approximately three-quarters of epileptic patients seen in consultation by specialists can easily be assigned to one of the diagnostic categories of the International League against Epilepsy. When patient age is taken into account, such a distribution shows that partial epilepsy is more common than generalized epilepsy (62% versus 38%) in patients of all ages, especially in those over 15 years of age (78% versus 22%). In contrast, generalized epilepsy is more frequent in subjects under 15 than partial epilepsy (55% versus 45%). In this younger age group the rarity of partial epilepsy is primarily due to the infrequency of temporal lobe epilepsy (21% of cases, as opposed to 56% in subjects over 15), whereas both primary and secondary generalized epilepsy contribute to the frequency of generalized epilepsy in this group.     

Three different points of view in stroke rehabilitation: patient,caregiver, and physiotherapist

Abstract

Background:

The similarities or differences of the threesome (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation.

Objective:

The aim of this qualitative study was to investigate the perspectives of the threesome, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you?

Methods:

The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices.

Results:

One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physiotherapists, were included to the study. When the theme 1 were examined, we found that the patients’ first priority was functional abilities (ICF: body function and structure) such as using the hands and feet while the caregivers and physiotherapists prioritized self-care problems (ICF: activity and participation). The most common response to the theme 2 was “being in same health condition before the disease” (ICF: activity and participation) among the patients and caregivers and “being able to move arm and leg on the affected side” (body function and structure) among the physiotherapists.

Conclusion:

As a conclusion, problems faced by the patients, caregivers, and physiotherapists were perceived under the same ICF domain and that caregivers’ and physiotherapists’ priorities were the same.     

The World Health Organization International Classification of Functioning, Disability, and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy

The way we think about health and disease determines to a considerable extent what we do and say in our clinical encounters with patients. The recent publication and promotion of the World Health Organization's International Classification of Function, Health, and Disability (known as the ICF) represents an exciting new way to consider health and disease. In the context of children and youth with cerebral palsy, this model offers many heretofore ignored "point of entry" for counselling and intervention with these conditions. This model also provides many possibilities to explore research questions with a fresh approach. This article outlines the ICF model and discusses these opportunities.