Parental priorities in the home care of preterm and full term newborns.

BACKGROUND: The initial weeks after hospital discharge is a period of adaptation when parents assume great responsibility for the care of their child. Preterm birth may impact their demands of care. AIMS: To compare parental priorities in the care of preterm and full-term newborns in the first two months after hospital discharge and to identify changes in priorities over time. METHODS: Parents of 22 full-term and 19 preterm infants were followed for two months after hospital discharge, with three timepoint evaluations of the parental priorities. They reported on infant care demands in a semi-structured interview. RESULTS: Despite prematurity, demands were similar between groups. Within-group changes occurred over time. Priorities related to bathing and caring for the navel showed significant reduction (p < 0.01); demands related to children's health care increased in the groups (p < 0.01). Feeding and sleep priorities were reduced in the full-term group (p < 0.02). Children's adaptation to routine increased significantly in the preterm group (p = 0.04). CONCLUSION: Knowledge of parents' priorities in caring for preterm or full-term newborns at home helps health care teams develop appropriate support strategies and improve specialized assistance to the families.

Adapted version of constraint-induced movement therapy promotes functioning in children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy. DESIGN: A single-blinded randomized clinical trial. SUBJECTS: Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months). INTERVENTIONS: Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period. MAIN MEASURES: Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care. RESULTS: Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P =0.0134; d(independence)=1.37; P =0.0001) and follow-up (d(functional skills) = 2.08, P =0.004; d(independence) = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention. CONCLUSIONS: The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.

Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial.

OBJECTIVE: We compared children's self-care performance and caregivers' perception of children's performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive training (HABIT). METHOD: Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children's daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention. RESULTS: Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04). CONCLUSION: The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children's daily functioning.

Clusters of daily functioning and classification levels: agreement of information in children with cerebral palsy.

PURPOSE: To analyze the agreement between gross motor and hand function levels and clusters of functional performance in children with cerebral palsy (CP). METHOD: The sample consisted of 129 children with CP aged 4 to 13~years. Children's gross motor and hand function were classified with the gross motor classification system (GMFCS) and manual ability classification system (MACS). Their daily functioning on self-care and mobility was assessed with the Pediatric Evaluation of Disability Inventory (PEDI). Cluster analyses grouped children with similar repertoires on self-care and mobility skills using the agglomerative hierarchical technique. The associations across self-care and mobility clusters with daily living skills were tested with Chi-Square tests. The level of agreement was quantified with the Kappa coefficient. RESULTS: Four groupings of children's functional skills in self-care (R2 = 0.92) and mobility (R2 = 0.95) were identified. These groupings were associated with hand function (χ2 = 145.43; p< 0.001) and mobility levels (χ2 = 198.13; p < 0.001), respectively. The agreement between MACS and self-care skills was 61.7% (Kappa=0.47; p< 0.001) and between GMFCS and mobility skills was 64.4% (Kappa=0.54; p< 0.001). CONCLUSION: The findings support the adequacy of functional classifications and functioning repertoires. The magnitude of agreement reinforces the importance of the concomitant use of functional classification and assessments.

Clinical changes during an intervention based on constraint-induced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report.

The objective of this study was to test the feasibility of a treatment programme based on the elements of constraint-induced movement therapy (CIMT) to encourage use of the affected arm of a child with obstetric brachial plexus injury (OBP), as well as to document clinical changes observed with this intervention. A 2-year-old female child with Erb's palsy had 14 weeks of daily home-based treatment with 30-minute sessions planned according to the principles of CIMT. The child was assessed every 2 weeks with the Toddler Arm Use Test. Test scores throughout the intervention period demonstrated improvements in quality of movement, amount of use and willingness to use the affected extremity. The child's mother reported improved ability to perform bimanual activities at home. The results suggest that treatment based on CIMT principles has potential to promote functional gains for children with OBP. Experimental studies should test the effects of this kind of intervention for children with OBP.