Pain in persons with cerebral palsy.

OBJECTIVE: To examine the nature and scope of pain in persons with cerebral palsy (CP). DESIGN: Standardized interviews to assess demographics, pain experiences, and the impact of pain on activities. SUBJECTS: Ninety-three adults with CP recruited from medical clinics at the University of Washington and local residential and community housing for persons with developmental disabilities. MAIN OUTCOME MEASURES: Weekly and 3-month pain intensities, chronic pain grade, interference in daily activities caused by pain, and pain-exacerbating and pain-relieving factors. RESULTS: Sixty-two subjects (67%) reported one or more areas of pain of > or =3 months' duration. Lower extremity pain and back pain were the most common complaints. Fifty-six percent of the subjects reporting pain indicated it occurred daily. Mean average pain intensity, graded on a scale of 0 (no pain) to 10 (pain as bad as could be), was 3.16 (SD = 2.45) in the preceding week and 4.45 (SD = 2.34) in the previous 3 months. Approximately 53% of subjects reporting pain indicated their average pain was of moderate to severe intensity (average pain rated as > or =5). Using Von Korff's Chronic Pain Grade classification system, the majority of subjects who reported pain fell into either grade I (low disability, low pain intensity; 51%) or grade II (low disability, high pain intensity; 39%). Subjects reported many factors that exacerbate pain (eg, stress or weather) or decrease it (eg, exercise or rest). CONCLUSIONS: The data suggest that pain is common in adults with CP. In many subjects, pain levels were moderate to intense.     

Testing an AAC system that transforms pictograms into natural language with persons with cerebral palsy

In this article, we describe a compansion system that transforms the telegraphic language that comes from the use of pictogram-based augmentative and alternative communication (AAC) into natural language. The system was tested with four participants with severe cerebral palsy and ranging degrees of linguistic competence and intellectual disabilities. Participants had used pictogram-based AAC at least for the past 30 years each and presented a stable linguistic profile. During tests, which consisted of a total of 40 sessions, participants were able to learn new linguistic skills, such as the use of basic verb tenses, while using the compansion system, which proved a source of motivation. The system can be adapted to the linguistic competence of each person and required no learning curve during tests when none of its special features, like gender, number, verb tense, or sentence type modifiers, were used. Furthermore, qualitative and quantitative results showed a mean communication rate increase of 41.59%, compared to the same communication device without the compansion system, and an overall improvement in the communication experience when the output is in natural language. Tests were conducted in Catalan and Spanish.     

Comparison of anterior trunk supports for children with cerebral palsy

The purpose of this study was to demonstrate outcome measures of one seating component--anterior trunk supports--when used by children with cerebral palsy during a functional activity. The functional activity was pressing a single switch to activate a computer software program. Seventeen children with a mean age of 9 years were included in the study. Subjects had mild to moderate spastic or athetoid cerebral palsy. Seven had a primary diagnosis of athetoid and 10 had a primary diagnosis of spastic cerebral palsy. All subjects needed supplemental seating to maintain an upright posture. The four trunk supports tested were an anterior chest panel, a 1-inch-wide single horizontal chest strap, an anterior shoulder support, and a tray with molded chest support. Data included prehits, response time, and the length of time the subject pressed the switch. A repeated analysis of variance test was used to analyze the data. Data for athetoid and spastic cerebral palsy subject groups were analyzed separately. No statistically significant differences were found between the four trunk supports. Therefore, the choice of trunk supports for this population should be based on client preferences, ease of removal for the caregiver, cost, and aesthetics.     

Performing bimanual activities: the experiences of young persons with hemiplegic cerebral palsy.

This qualitative research study was designed to explore and describe the process of planning and performing bimanual activities in young persons with hemiplegic cerebral palsy. Interviews with 10 persons individually and four persons in a focus group provided rich information about their reasoning when confronting problems as well as insight into how they view their situations. The data were analyzed using a comparative method. The findings show that the participants had to make conscious choices about what would be the most effective strategies to use for carrying out activities. The choices involved weighing different options to find the least negative alternative. Even when able to find alternative strategies for performing the activity, the participants were often dissatisfied with negative consequences related to the strategy. Examples of such negative consequences could be, for example, that they would have to accept a need for extra time, planning, or concentration, to perform desired activities. When selecting a strategy it was thus favorable to have a repertoire of strategies from which to choose. In conclusion, the planning and performing of bimanual activities turned out to be a complex process influenced by a range of factors both internal and external to the person.     

Self-esteem of persons with cerebral palsy: from adolescence to adulthood

A longitudinal study of self-esteem in 22 adolescents with cerebral palsy is reported. The subjects were matched with nondisabled adolescents by age, sex, IQ, and school. Seven years later, 39 of the 44 subjects (mean age = 22.8 years) completed the Tennessee Self-Concept Scale (Roid & Fitts, 1988), the Social Support Inventory (McCubbin, Patterson, Rossman, & Cooke, 1982), and a demographic questionnaire with some open-ended questions. As adolescents, the girls with cerebral palsy scored significantly lower than the other groups on physical, social, and personal self-esteem; however, as adults, these subjects were no longer significantly different from the other groups. Male subjects with cerebral palsy had self-esteem scores similar to those of the nondisabled groups in both adolescence and adulthood. Demographic information is summarized. The factors that the subjects identified as leading to changes in self-esteem were relationships and experiences. The low self-esteem scores indicate that psychosocial occupational therapy intervention with adolescent girls with cerebral palsy and with some adults with cerebral palsy would be appropriate.     

3岁以上脑瘫患儿拐杖训练方法

健康儿童的扶站、扶行至独行等大运动发育一般是在出生后 9个月左右开始 ,1岁左右完成 ,大约需3— 4个月的时间 ,而且这种大运动能力是在此阶段每日起床后约 5— 6个小时的活动中获得的 (通过神经生理学、运动学 ,以及系统发生学等诸多方面相关联作用共同协调完成 )。由于脑瘫患儿使用拐杖的前提条件与其躯干发育的成熟度和双上肢机能状况有关 ,为此 ,东京都立北疗育园康复科制定了LS度、CC度评定标准 ,以供参考。本文介绍脑瘫患儿进行拐杖训练的评定及拐杖训练进度等内容。1LS度与CC度评定标准1.1LS度评定标准 (longlegstandingstabili…     

Occupational therapy's role in improving the quality of life for persons with cerebral palsy

Adults with cerebral palsy need assistance to maximize their capabilities, interact with others, and achieve independence. They experience difficulty communicating their needs to successfully obtain medical/rehabilitation and independent living services, which are necessary to achieve independent living. Knowledge of the experience of such clients can help occupational therapists to better serve them. This study, which used a case study design, presents data collected during more than 80 hours of guided interviews with 5 study participants. A data analysis of the participants' experiences showed recurring themes of the disability as the enemy, the importance of attitude, dependence versus independence, and the significance of purposeful activity. The participants' experiences with therapists and independent living skills agencies are presented, as is an examination of the medical/rehabilitation and independent living models.     

Pain in persons with cerebral palsy: extension and cross validation

OBJECTIVE: To cross-validate and extend the assessment of pain in persons with cerebral palsy (CP). DESIGN: Standardized in-person interviews. SETTING: University medical clinics and local residential and community housing for persons with developmental disabilities. PARTICIPANTS: One hundred adults with CP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures of pain intensity, pain interference in daily activities, psychologic function, significance of pain problem, and satisfaction with pain treatment. RESULTS: Sixty-seven (67%) subjects reported 1 or more chronic pain problem(s). Low back, hip, and leg pain were most common. Twenty-four percent reported constant pain; 19% reported that pain occurred daily. Mean pain intensity +/- standard deviation over the previous week on an 11-point scale (0, no pain; 10, pain as bad as could be) was 4.08+/-2.25. Minor interference (2.55+/-3.03; scale range, 0-10) from pain with routine daily activities was reported. Responses to the Satisfaction with Life Scale (n=63) indicated only moderate life satisfaction (18.44+/-8.34; scale range, 5-35) among those with 1 or more pain problem(s). Responses to the Rand Mental Health Inventory (n=65; mean score, 60.65+/-20.36) revealed relatively high levels of psychologic distress in those with chronic pain. Consumer satisfaction with pain management care varied, with 32.8% of the subjects reporting dissatisfaction. CONCLUSIONS: The study findings are consistent with earlier findings concerning pain problems in adults with CP and provide further evidence that pain problems may be overlooked and undertreated in this population.     

Head-erect behavior among three preschool-aged children with cerebral palsy

This article presents the results of a multiple baseline design, across subjects, to assess the effect of vibratory stimulation on head-erect behavior in subjects who were prone. The subjects were three children with severe multiple handicaps whose mean age was 2 years 4 months and whose conditions included seizures and muscle tone disorders. Frequency of head lifts and cumulative duration of head-erect behavior were recorded during three-minute sessions with the subjects positioned prone on their forearms over a wedge. After baseline observations were recorded, vibration was applied to the paraspinal muscles of the neck and upper back for the first two minutes of each intervention session. In addition, electromyographic activity was recorded for a three-minute session at least once during both the baseline and intervention conditions. Results of the study demonstrated an increase in the cumulative duration of head-erect behavior for the three subjects and an accompanying increase in EMG activity during muscle vibration. The diversity of handicapping conditions (ie, seizures, hypertonia, and hypotonia) appeared to have no effect on the benefits received from muscle vibration for these subjects. Limitations of the study and implications for future research are discussed.     

上田法与 Bobath法治疗脑性瘫痪的疗效分析

目的探讨上田法与Bobath法治疗脑性瘫痪(脑瘫)的疗效。方法将脑瘫患儿64例,随机分为观察组采用上田法治疗,对照组采用Bobath法治疗。治疗前、后进行量化评价。结果两组病人在总的评分无显著性差异,对坐位功能的改善和促进降落伞反应的建立也有显著性差异(t=2.19,χ2=4.08,P<0.05)上田法为73%,Bobath法为62%。结论两种方法治疗脑瘫均有效,但上田法在坐位功能和阳性支持反应的改善以及促进降落伞反应的建立更占优势。     

Dynamic foot pressure measurements for assessing foot deformity in persons with spastic cerebral palsy

OBJECTIVES: To identify characteristics of foot pressure distribution in different foot deformities using a computerized insole sensor system, and to identify changes in these parameters after corrective surgery in children with spastic cerebral palsy (CP). DESIGN: Before-after trial. SETTING: University hospital. PARTICIPANTS: Sixty-seven limbs of 44 children with spastic CP were assessed (35 equinus, 17 equinovarus, 15 equinovalgus). INTERVENTION: Orthopedic surgery for foot deformities. MAIN OUTCOME MEASURES: Parameters of foot contact pattern, pressure-time integral (PTI), and center of pressure (COP) trajectories were assessed before and at a minimum of 6 months postsurgery, using the F-scan system. RESULTS: Prior to surgery, the medial midfoot relative impulse, which is PTI normalized by a percentage of the entire foot, differed significantly between foot deformity groups. Relative impulse was high on the lateral column of the foot in the equinovarus group and on the medial column of the foot in the equinovalgus group. Center of pressure index (COPI) and coronal index reflecting the asymmetry of the medial and lateral columns of the foot differed significantly between the equinovalgus and equinovarus groups. After surgery, significant changes occurred in foot contact patterns, including total contact area, contact length, contact width of hindfoot, and the relative impulse of specific areas of the foot. In addition, there were significant changes in the parameters of COP, such as anteroposterior displacement, slope, and velocity. CONCLUSIONS: In dynamic foot pressure measurements using a computerized insole sensor system, the parameters reflecting medial or lateral changes in weight bearing, such as COPI and coronal index, appear to be useful for evaluating abnormalities and improvements after intervention in the frontal plane, such as varus and valgus. Additionally, assessment of parameters in foot contact patterns, PTIs, and COP path trajectories appears to be helpful in evaluating outcomes after corrective surgery.     

The relationship between oral sensation and drooling in persons with cerebral palsy

This study examined the relationship between oral sensation and drooling in persons with cerebral palsy. The sample was composed of 40 subjects between 5 and 21 years of age who had a diagnosed condition of cerebral palsy. Twenty of the subjects had a drooling problem and 20 did not. The subjects were randomly selected from two Montreal schools for the disabled. The experimental procedure consisted of the administration of three tests of oral sensation: a test of oral stereognosis, a test of oral form discrimination, and a test of lingual two-point discrimination. In addition, saliva was quantified in those subjects who drooled. The results suggested a relationship between oral stereognosis and drooling in persons with cerebral palsy. The main implication for occupational therapists is that the assessment and treatment of drooling in people with cerebral palsy should address both the sensory and motor elements of oral function.