IMPROVEMENT IN WALKING PERFORMANCE OF CHILDREN WITH CEREBRAL PALSY: PRELIMINARY RESULTS

The effect of four to six months use of ankle-foot orthoses (AFOs) and balance training was determined for six children with cerebral palsy. The six consecutively referred patients had spastic diplegia or hemiplegia, with hyperextension of the knee, and had accurate voluntary control of the trunk and hips. Fixed AFOs were adjusted to control the position of the ground reaction force in relation to the knees. Balance training was targeted to the knees. All children showed a decrease in the magnitude of the knee-extending moment arm toward normal when barefoot. Improvement was noted in foot-ground contact for three children and of stance-phase posture for three. These improvements were not related to range of motion or speed, and a motor learning effect is proposed. The value of monitoring the moment arm is emphasised.     

Family presence during resuscitation and invasive procedures

The practice of allowing family to be present during patient resuscitation or invasive procedures (Family Presence) is gaining acceptance in North America and the United Kingdom in controlled circumstances. Research into Family Presence has demonstrated multiple benefits for the patient, family and health care team. These advantages include helping the family to understand the severity of the illness/trauma and to see that appropriate attempts were undertaken to save their loved one. Family Presence can also facilitate improved communication between the health care team and family. In spite of evidence supporting Family Presence as a useful practice for patient, family and health care team, the use of Family Presence is uncommon within Australian emergency departments and hospitals. Clear expectations at organisational, governmental and professional levels are essential to effectively implement this approach. To be supported in the clinical area, the success of a Family Presence program requires an inclusive approach to program development. A critical component of a successful Family Presence program is a family facilitator who is adequately prepared for the role and committed to supporting the family during resuscitation or invasive procedures. Research exploring Family Presence in Australia is lacking and highlights the need for context specific research in this area.