Cognitive approach to rehabilitation in children with hyperkinetic movement disorders post-DBS.

OBJECTIVE: This proof-of-concept feasibility trial examined the potential of the Cognitive Orientation to daily Occupational Performance Approach (CO-OP) to augment deep brain stimulation (DBS) outcomes in childhood-onset hyperkinetic movement disorders (HMD) including dystonia and dyskinetic cerebral palsy. METHODS: This is a single case experimental design using multiple baseline as n-of-1 trial comprising 10 intervention sessions, with replications across participants (n = 10). Treatment focused on 3 participant-selected goals. Transfer was assessed on 2 additional untreated goals. Individuals enrolled were 6-21 years of age and had DBS in situ and sufficient manual ability. Primary outcome was functional performance change on the Performance Quality Rating Scale-Individualized (PQRS-i) measured before, during, and posttreatment, and at 3-month follow-up. Assessors of outcome were blinded to time of assessment, number of intervention session, and treatment allocation. To measure effect size, a nonoverlapping index, Tau-U, was used. Feasibility measures were captured. RESULTS: One participant withdrew before baseline assessment. Effect sizes of at least 0.66 were seen at both posttreatment and follow-up with all participants showing improvements in at least one trained goal in PQRS-i. Six participants improved on all 3 goals and 2 improved on 2 trained goals. Two children showed deterioration in one trained goal each. Transfer to untrained goals was observed in 3 participants for a total of 5 goals. CO-OP was feasible and acceptable to all participants. CONCLUSION: A cognitive-based, task-oriented approach to support performance of personally relevant functional skills enabling participation is acceptable in childhood-onset HMD post-DBS. Further, preliminary efficacy to improve outcomes and proof of concept with CO-OP has been established in this population. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for children with HMD who had undergone DBS, CO-OP improves performance of personally relevant functional skills.

The International Classification of Functioning (ICF) to evaluate deep brain stimulation neuromodulation in childhood dystonia-hyperkinesia informs future clinical & research priorities in a multidisciplinary model of care.

The multidisciplinary team (MDT) approach illustrates how motor classification systems, assessments and outcome measures currently available have been applied to a national cohort of children and young people with dystonia and other hyperkinetic movement disorders (HMD) particularly with a focus on dyskinetic cerebral palsy (CP). The paper is divided in 3 sections. Firstly, we describe the service model adopted by the Complex Motor Disorders Service (CMDS) at Evelina London Children's Hospital and King's College Hospital (ELCH-KCH) for deep brain stimulation. We describe lessons learnt from available dystonia studies and discuss/propose ways to measure DBS and other dystonia-related intervention outcomes. We aim to report on current available functional outcome measures as well as some impairment-based assessments that can encourage and generate discussion among movement disorders specialists of different backgrounds regarding choice of the most important areas to be measured after DBS and other interventions for dystonia management. Finally, some recommendations for multi-centre collaboration in regards to functional clinical outcomes and research methodologies for dystonia-related interventions are proposed.

Head start participation and school readiness: evidence from the Early Childhood Longitudinal Study-Birth Cohort.

Using data from the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6,950), a nationally representative sample of children born in 2001, we examined school readiness (academic skills and socioemotional well-being) at kindergarten entry for children who attended Head Start compared with those who experienced other types of child care (prekindergarten, other center-based care, other nonparental care, or parental care). Using propensity score matching methods and ordinary least squares regressions with rich controls, we found that Head Start participants had higher early reading and math scores than children in other nonparental care or parental care but also higher levels of conduct problems than those in parental care. Head Start participants had lower early reading scores compared with children in prekindergarten and had no differences in any outcomes compared with children in other center-based care. Head Start benefits were more pronounced for children who had low initial cognitive ability or parents with low levels of education or who attended Head Start for more than 20 hr per week.

[Restoration of voluntary movements in adolescents with the hyperkinetic form of children cerebral paralysis by means of special physical exercises].

Results of a study involving 12 adolescents presenting with the hyperkinetic form of childrens' cerebral paralysis are reported. The principal manifestation of the disease in these patients was the inability to perform coordinated movements because of muscular dystonia and hyperkinesia. The long-term course of special physical exercises and two courses of training with a Heyvus training apparatus resulted in the improvement of statodynamic functions compared with control patients.

Hyperlocomotion associated with transient prenatal vitamin D deficiency is ameliorated by acute restraint.

Transient prenatal vitamin D deficiency produces hyperlocomotion in the adult rat. The aim of this study was to examine the effects of acute restraint on the behaviour of DVD and control rats in the open field. Rats were conceived and born to developmentally vitamin D (DVD) deficient or replete (control) dams and, at 8 weeks of age, were monitored for 30 min in an open field using automated video tracking software. Half of the rats were restrained within a towel for 5 min immediately before the open field test. The remainder received minimal handling prior to the open field test. Repeating previous findings, DVD deficient animals had enhanced locomotion during the first 10 min of the open field test compared to control rats. By contrast, there were no differences in locomotor activity after acute restraint stress. The time rats spent in the corners and side of the open field was affected by prenatal diet. DVD rats spent less time in the corners and more time in the side than control rats across the whole 30 min test. This difference was not seen in rats with acute restraint stress. The time spent in the centre was not altered by prenatal diet or acute restraint. Thus, transient prenatal vitamin D deficiency induces a transient spontaneous hyperlocomotion in adulthood that is modulated by acute restraint stress.

An association of Ephedra use with psychosis and autonomic hyperactivity.

Ephedra extract is used in a number of dietary supplements taken for a variety of purposes including weight loss. Although recent events have led to calls for Ephedra to be removed from the market and the FDA has had over 18,000 adverse event reports, newspaper reports cite only a few instances of clearly associated adverse events associated with Ephedra use. In this communication, we review the literature and present a case report of Ephedra use associated with the onset of psychosis and autonomic hyperactivity after administration of risperidone. We conclude that the behavioral effects of Ephedra are a public health concern.

New approaches to the rehabilitation of patients with neurological movement defects.

Results were obtained using a new method, based on the "Adeli-92" therapeutic space suit, for the rehabilitation of patients with movement disorders due to acute lesions of the cerebral circulation, head trauma, and other causes. A variety of methods was used to assess the state of patients before and after treatment, including clinical studies, psychological tests, EEG recordings, evoked potential studies, stabilography, and heart rhythm analysis. The results obtained demonstrate the high efficacy of this new method.

[Habilitation for handicapped children, mainly for children with visual and hearing impairment, speech-language disorder, and hyperkinetic disorder].

This symposium was focused on habilitation for children with visual and hearing impairment, speech-language disorder, and hyperkinetic disorder. New and variable approaches were reported in topics of habilitation for these handicapped children by an ophthalmologist, an otorhinolaryngologist, a child neurologist, a speech therapist and an educational psychologist. Many points of these approaches were then discussed.

[Changes in the clinical electromyographic indices of patients with the hyperkinetic form of infantile cerebral palsy and their dynamics during combined sanatorium-health resort treatment including transcerebral exposure to an ultrahigh-frequency electrical field]. / Izmeneniia kliniko-élektromiograficheskikh pokazatelei u bol'nykh s giperkineticheskoi formoi detskogo tserebral'nogo paralicha i ikh dinamika pri kompleksnom sanatorno-kurortnom lechenii s vkliucheniem transtserebral'nogo vozdeistviia élektricheskogo polia ul'travysokoi chastoty.

Clinical electromyographic studies were made to evaluate the efficacy of transcerebral exposure to UHF electric field which has been used as an adjuvant to therapeutic exercise, massage, climate treatment in 33 patients with hyperkinetic infantile cerebral paralysis (ICP). The effect on the motor disorders reached 70.8%. Specific features of statokinetic function in hyperkinetic ICP children recorded electromyographically dictate combined use of various modalities (therapeutic exercises, preformed physical factors, games, reflex therapy, etc.) to improve therapeutic actions on vestibular apparatus.

[The potentials of manual therapy in the neuromotor correction of the statokinetic disorders in infantile cerebral palsy]. / Vozmozhnosti manual'noi terapii v neiromotornoi korrektsii statokineticheskikh narushenii pri detskom tserebral'nom paraliche.

It is shown that manual therapy to abolish functional cervical and lumbar blocks is beneficial in reducing spasticity of the synergic muscles, biomechanic characteristics of the support and kinematic pace phases improve. Manual therapy in multimodality rehabilitation treatment of cerebral paralysis creates a functional base for neuromotor correction of a defective motor stereotype in these patients.

Home vs hospital care of children with behavior disorders. A controlled investigation.

A controlled investigation was conducted to assess and compare the treatment outcomes of community and hospital care for children with behavior disorders. Findings showed that (1) community care was effective with regard to behavioral control, and (2) both treatments were comparable concerning educational achievement, parent role function, family adjustment, and parent satisfaction with treatment. It was noted that many severely disturbed children who are in dire socioeconomic predicaments can be maintained in the community with special care and intervention.

Hyperkinetic impulse disorder: a developmental defect of motivation.

An integrated, testable, bio-psychological theory which proposes that hyperkinetic impulse disorder (H.I.D.) is determined interactively by polygenically inherited and environmental factors is presented and examined in the light of the literature. The theory holds that H.I.D. is a developmental disorder of intrinsic motivation, characterized by poor appreciation of the contingencies between behavior and environmental events. Characteristics of H.I.D. children, including apparent overactivity, impulsivity, impersistence, inattention, and underachievement in academic and social skills, are accounted for, and implications for treatment and management are spelled out.

The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys.

Twenty boys (6-8 years) rated by their teachers as hyperactive and a matched sample of nonhyperactive boys performed a task that required them to withhold responding for a set time interval in order to be rewarded (DRL 6-second schedule). Half of each group worked on a one-button console while the other half was provided with additional collateral buttons. Results indicated that hyperactive children were relatively unable to perform efficiently on the task, and that this deficit endured regardless of age, IQ, or experimental condition. DRL was thus found to discriminate accurately between teacher-rated and parent-rated hyperactive and nonhyperactive children. Furthermore, a wide variety of self-generated mediating behaviors was observed, and it was determined that a child's DRL performance was related to the kind of mediating behaviors he displayed. Results are discussed in terms of the clinical assessment of hyperactivity and the training of impulsive children.

The effects of EMG-assisted relaxation training with hyperkinetic children: a behavioral alternative.

Six developmentally hyperkinetic children, ages 6 to 9, participated in either an A-B-A-B-A or an A-B-A-BC-A research design to evaluate the effect of EMG-assisted relaxation training in the acquisition of self regulatory skills to decrease hyperkinetic behavior. Descriptive verbal feedback regarding subject performance was provided during the BC phase in addition to the continuous rate-proportional auditory feedback normally available. Posttraining psychological assessment yielded significant gains for the experimental group on various visual motor tasks at the .05 level. All six subjects significantly decreased EMG activity across the 15 sessions. In a follow-up, five of the six maintained such activity at or below levels reached at the conclusion of the study. Five out of six made significant behavioral improvements at home during training and were maintaining these at the follow up. One out of four made significant improvements in school behavior during training, with five out of six exhibiting such improvements at the follow-up during the next school year. Auditory feedback was effective at the .05 level; the benefit of the verbal feedback, however, was not demonstrated. Two subjects were maintained on stimulant medication, one with a slight dose reduction during training. According to the observations of their parents and teachers, four subjects for whom medication had been recommended prior to the training were subsequently judged not to need it at the time of the follow-up.

[Appraisal of work capacity and rehabilitation in infantile cerebral palsy]. / Voprosy ékspertizy trudosposobnosti i reabilitatsii pri detskom tserebral'nom paraliche.

In clinical conditions 189 patients with infantile cerebral paralysis were examined, and ways of their medical, family, social, and working rehabilitation were analyzed. The medical rehabilitation appeared to be the most effective in patients with pareses of the extremities and speech disorders. The prognosis as regards the working capacity was the most favourable in patients with mild and mode;ate pareses (hemi-, para-, and fetrapareses) and unfavourable in patients with severe hyperkinesias, pronounced oligophrenia, and combined pathology (hyperkinesias + tetrapareses; tetrapareses + debility and/or speech disorders). While specifying the disability groups attention was paid to the degree of the function impairment (mild, moderate, grave) and to the working prognosis. Patients with pronounced tetrapareses and contractures in all the joints, grave hyperkinesias in all the four extremities, and imbecility were classed with disability group I: those with pronounced para-, hemi-, and tetrapareses, extensive hyperkinesias, combination of the motor disorders with debility were placed into disability group II. While classing patients with disability group III the character and degree of the function impairments, the patients profession, contraindicated factors of the work, and compensatory potentialities were taken into account. The studies have shown that the existing scepticism with regard to the working capacity prognosis in patients with infantile cerebral paralysis is due to insufficient elucidation of their working potentialities in literature.

Stereotactic amygdalotomy for convulsive and behavioral disorders. Long-term follow-up study.

58 patients, whose convulsions and behavioral disorders did not respond to nonsurgical therapy, were treated with stereotactic amygdalotomy between 1963 and 1973. A retrospective study was carried out by a psychiatric research team 1--11 years postoperatively. Using reliable objective methods of assessment they found that 50% operated primarily for seizures, 33% for uncontrolled conduct disorders and 50% with both conditions seemed improved after surgery.