Do adolescents with cerebral palsy meet recommendations for healthy weight and physical activity behaviours?

Purpose: Describe physical activity energy expenditure, body composition, and nutritional intake in adolescents with cerebral palsy (CP) in the context of health recommendations.Materials and methods: A cross-sectional study of 12 adolescents, aged 12-19 years, with CP, classified as Gross Motor Function Classification System levels II-V. Actiheart® accelerometry assessed daily physical activity energy expenditure; Dual Energy X-ray Absorptiometry (DXA) and skinfold assessment measured percentage body fat; the Modified Nutrition Questionnaire for children aged 12-18 years assessed nutritional intake.Results: These adolescents spent per day a median of 413.3 min in sedentary (range: 90.0-621.9), 206.2 min in light activity (range: 48.4-509.5), and 65.5 min in moderate-vigorous physical activity (MVPA) (range: 9.4-363.9). Sixty-four percent of the participants met guidelines for time spent in MVPA, only one participant (9%) met the target for sedentary behaviour, and one (9%) participant reached all of the nutritional targets. Participants had a median percentage body fat of 43% by DXA and 40.3% by skinfold assessment. Seventy-three percent of the participants were classed as having a potentially unhealthy body composition according to percentage body fat.Conclusions: Adolescents with CP may have a high percentage body fat, and high levels of both sedentary activity and moderate-vigorous physical activity.Implications for rehabilitationCerebral palsy specific strategies to decrease time in sedentary activity need to be determined as adolescents were not meeting national guidelines, however, most did meet guidelines for time spent in moderate to vigorous physical activity.Percentage body fat should be monitored in adolescents with cerebral palsy, as adolescents with cerebral palsy tend to have a high body fat ratio, despite some recording Body Mass Index within a healthy range.Triceps and subscapular skinfold assessment accurately assess percentage body fat in adolescents with cerebral palsy.

A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM.

This systematic review examines the effects of casting, either alone or in combination with botulinum toxin type A (BTX-A), on equinus in children with cerebral palsy (CP). Comparisons are made between casting alone and no treatment, between casting alone and BTX-A alone, between combined casting and BTX-A and each treatment by itself, and between casting followed by BTX-A and BTX-A followed by casting. A search of PUBMED, CINAHL, Proquest Health and Medical Complete, Cochrane Database of Systematic reviews, Physiotherapy Evidence Database (PEDro), OTseeker, Database of Reviews of Effectiveness (DARE), and Infotrieve yielded 184 citations. Articles were included in the review if they reported the effects of an intervention using casting for equinus in particpants with CP aged 20 or less, if they appeared in a peer-reviewed scholarly journal in 1970 or later, with no language restriction, and if casting was not used in conjunction with surgery. Twenty-two articles were selected, including seven randomized controlled trials (RCTs). There is little evidence that casting is superior to no casting, but the protocols of casting in current use have not been compared with no treatment in any RCT. There is no strong and consistent evidence that combining casting and BTX-A is superior to using either intervention alone, or that either casting or BTX-A is superior to the other immediately after treatment. Finally, there is no evidence that order of treatment (casting before BTX-A versus BTX-A before casting) affects outcome. Much of the evidence both for and against differences is weak, and results may be explained by methodological limitations. Future research needs to use adequate sample sizes, long-term follow-ups, and broader and more global measures.

The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache.

This single-blind comparative group design aimed to investigate the sensitivity and specificity of the cervical flexion-rotation test in the diagnosis of C1/2-related cervicogenic headache. This study tested 23 cervicogenic headache, 23 asymptomatic controls and 12 migraine with aura subjects, all aged 18-66 years. In stage 1, an experienced manipulative physiotherapist who did not partake in the flexion-rotation test procedure identified C1/2 dysfunction using passive segmental mobility tests in the cervicogenic headache group. Those with C1/2 dysfunction participated in stage 2. In stage 2, using the flexion-rotation test, subjects were tested by two experienced manipulative physiotherapists blinded to the subjects' group allocation. Each therapist stated whether the test was positive or not based on the therapist's interpretation of range of motion. The sensitivity and specificity of the flexion-rotation test was 91% and 90%, respectively (P<.001), with an overall diagnostic accuracy of 91% (P<.001). The cervical flexion-rotation test significantly assists in the differential diagnosis of cervicogenic headache and in the identification of movement impairment at the C1/2 segment in patients with cervicogenic headache.

Benefits of an education programme on the self-management of aerosol and airway clearance treatments for children with cystic fibrosis.

Adherence to recommended aerosol medicines and airway clearance techniques (ACT) for children with cystic fibrosis (CF) requires self-management skills. A multi-centre, randomized, controlled trial was conducted to investigate the effectiveness of a self-management education programme called 'Airways' for six- to 11-year old children with CF and their caregivers. Assessments were conducted immediately before and after the intervention period, and six and 12 months after the post-intervention assessment. The pen and paper education programme was completed by the child and caregiver together at home. Participants in the intervention and control groups had similar baseline characteristics. A per-protocol analysis was conducted and for variables that changed significantly, an additional intention-to-treat analysis was performed that included data from participants in the intervention group who withdrew from the study during the intervention period. The intervention group increased the percentage of prescribed aerosols taken (P < 0.001) and this was maintained at 12-month follow-up (P < 0.001). There was no change in the percentage of prescribed ACT performed, although when the child was unwell, caregivers in the intervention group increased the frequency and/or duration of ACT (P = 0.028) in the per-protocol analysis but not in the intention-to-treat analysis. Children in the intervention group increased their knowledge of ACT (P < 0.001) which was maintained at 12-month follow-up (P < 0.001) and felt more positively about their chest treatment regimens immediately following the intervention (P = 0.017) but not at 12-month follow-up. There were no significant changes in the control group for these variables over time. No significant changes occurred in the caregivers' reports of self-management behaviours and self-efficacy in either group. The positive results suggest that 'Airways' is a valuable educational tool for primary school-aged children with CF and their caregiver.

Use of the measure of process of care for families (MPOC-56) and service providers (MPOC-SP) to evaluate family-centred services in a paediatric disability setting.

BACKGROUND: The value of family-centred principles in paediatric professional caregiving services is widely acknowledged. However, the degree to which such services adhere to these principles is not well documented. AIM: To examine the perceptions of both families and service providers of the extent to which family-centred services were being implemented by a paediatric disability service provider and to pinpoint areas for improvement. METHOD: A sample of 158 families receiving services from the Cerebral Palsy Association of Western Australia completed the Measure of Processes of Care for families (MPOC-56) and 43 clinicians (most of them physiotherapists, speech pathologists and occupational therapists) completed the Measure of Processes of Care for service providers (MPOC-SP). RESULTS: As in previous studies, the families rated 'respectful and supportive care' highest and 'providing general information' lowest. Clinicians rated 'showing interpersonal sensitivity' highest and 'providing general information' lowest. Analysis of individual items revealed that the following areas of family-centred services were in need of improvement: provision of general written information to families on a range of issues, continuity of care, greater involvement of the family in therapy and provision of more detailed information about therapy issues and provision of more general support to whole families. CONCLUSIONS: The MPOC tools have been found useful in enabling disability service providers to identify areas for improvement and move towards providing services that are more family centred.

Estimating the size of a potential palliative care population.

OBJECTIVES: To develop a method for estimating the population who could potentially benefit from receiving palliative care in the last year of their lives, and then apply the estimates to the Western Australian population to ascertain characteristics of these people. METHODS: Three estimates of the potential palliative care population, Minimal, Mid-range and Maximal, were developed through focus groups, interviews and the literature. These estimates were applied to the cohort of people who died in Western Australia between 1 July 2000 and 31 December 2002 by linking death records with hospital morbidity data through the Western Australian Data Linkage System. RESULTS: Between 0.28% and 0.50% of people in the Western Australian population in any one year could potentially benefit from palliative care, many of whom die from conditions other than neoplasms. While neoplasms accounted for 59.5% of all underlying causes of deaths in the Minimal Estimate, heart failure (21.0%), renal failure (9.8%), chronic obstructive pulmonary disease (9.6%), Alzheimer's disease (4.0%), liver failure (3.2%), Parkinson's disease (1.3%), motor neurone disease (0.9%), HIV/AIDS (<0.01%) and Huntington's disease (<0.01%) accounted for other conditions in this estimate. The study was expanded to include Mid-range and Maximal Estimates. Characteristics of the Western Australian population in these three estimates are described. CONCLUSIONS: Unlike traditional palliative care estimates that focus on malignant disease, this study included nonmalignant conditions in a set of three estimates of a potential palliative care population. By using population-based data to describe characteristics of people who compose palliative care populations, these results offer a tool for planning equitable healthcare services.

The use of questioning strategies by clinical teachers.

By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making and problem solving in students. This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. Although there was a variation in the number of questions asked, predominantly low level questions were asked by 26 clinical teachers at two post-clinical conferences. Based on the findings of this study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.

Effects of an environmental manipulation emphasizing client-centred care on agitation and sleep in dementia sufferers in a nursing home.

This study was designed to determine whether a change from a task-oriented care approach to a client-oriented care approach affects (a) the level of agitation and (b) 24-hour sleep in residents suffering from dementia in a nursing home. The levels of dementia and sleep of 33 nursing home residents were measured four times over 12 weeks (twice before and twice after the change in care approach) using the Cohen-Mansfield agitation inventory and the dementia mood assessment scale. Verbal agitation levels significantly decreased 6 to 8 weeks following the change, whereas more infrequent agitated behaviours, which were classified as 'other', significantly increased. Daytime sleep increased initially after the change but then returned to baseline levels after 6 weeks. While the main focus of the study was on residents' behaviour following an environmental manipulation, anecdotal observations of staff members interactions with residents indicated that they felt less rushed and were more tolerant of residents' behaviour following the intervention.

The use of props in a syntactic awareness task.

The study investigated the effects of using props to illustrate the meaning of sentences in a syntactic awareness task in which subjects were required to correct ungrammatical sentences. Forty preschool children (aged 4; 11 to 5; 11) were asked to correct 20 sentences, 10 of which were illustrated using props, and 10 of which were not. Children scored significantly higher in the props condition though the proportion of meaning-changing errors to total errors was not significantly lower in this condition. It is argued that the use of props, by providing contextual support, reduces the processing capacity required to complete the task.