Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up.

Aims: To examine changes in upper limb function, and performance in everyday tasks, for children with unilateral cerebral palsy who participated in a magic-themed hand-arm bimanual intensive therapy (HABIT). Methods: Twenty-eight children participated; mean age 10 y 6 mo (SD 2 y 2 mo), n = 15 male and n = 13 female. Using a single group, pre-and post-test design, the magic-themed HABIT was delivered for 60 hours over 10 days. Bimanual and unimanual hand function were measured using the Assisting Hand Assessment (AHA) and Box and Blocks Test (BBT). Occupational performance was rated using the Canadian Occupational Performance Measure (COPM). Two parent questionnaires explored change in bimanual hand use in everyday activities; ABILHAND-Kids and Children's Hand-use Experience Questionnaire (CHEQ). Assessments were completed pre-, immediately post, 3 months and 6 months after the intervention. Results: Friedman's ANOVA revealed a significant improvement for COPM and CHEQ grasp subscale. Repeated measures ANOVA revealed a significant improvement in BBT, and ABILHAND-Kids, and no significant change for AHA. Conclusions: Children who participated in the magic-themed HABIT experienced improved occupational performance, unimanual skills, and parent ratings of performance in challenging everyday tasks.

A magic-themed upper limb intervention for children with unilateral cerebral palsy: The perspectives of parents.

AIM: To explore parent's perspective of their child's participation in a magic-themed intervention called Amazing Magic Club (AMC), and to further our understanding of motivated engagement and the impact of themed group-based interventions for children with unilateral cerebral palsy (CP). METHODS: Twenty-nine parents of children with unilateral CP completed semi-structured interviews. The child participants (n = 28) attended one of three AMCs; average age of the children was 10y 6mo (SD 2y 2mo). The parent interviews were analysed using thematic analysis. RESULTS: The three themes are: "It's okay to be me", the magic effect and "I can do it". Parents observed their children to belong and learn about their abilities. The importance of the magicians and the performance is described. Parents observed their children to have increased self-belief and a new willingness to attempt difficult tasks. DISCUSSION: AMC appears to capture intrinsic motivation for children with unilateral CP to complete challenging tasks.

Carers' preferences for the delivery of therapy services for people with disability in rural Australia: evidence from a discrete choice experiment.

BACKGROUND: The implementation of the Australian National Disability Insurance Scheme is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However, little attention has been paid to examine how users of the National Disability Insurance Scheme will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. METHODS: A stated preference discrete choice experiment was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit and private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. RESULTS: A total of 133 carers completed the discrete choice experiment. The majority of respondents cared for a child with a disability (84%); the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out-of-pocket cost and travelling up to 4 h to receive a therapy session (P < 0.05). Sector providing the service was not statistically significant. CONCLUSION: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability.

A trans-Atlantic examination of haddock Melanogrammus aeglefinus food habits.

The food habits of Melanogrammus aeglefinus were explored and contrasted across multiple north-eastern and north-western Atlantic Ocean ecosystems, using databases that span multiple decades. The results show that among all ecosystems, echinoderms are a consistent part of M. aeglefinus diet, but patterns emerge regarding where and when M. aeglefinus primarily eat fishes v. echinoderms. Melanogrammus aeglefinus does not regularly exhibit the increase in piscivory with ontogeny that other gadoids often show, and in several ecosystems there is a lower occurrence of piscivory. There is an apparent inverse relationship between the consumption of fishes and echinoderms in M. aeglefinus over time, where certain years show high levels of one prey item and low levels of the other. This apparent binary choice can be viewed as part of a gradient of prey options, contingent upon a suite of factors external to M. aeglefinus dynamics. The energetic consequences of this prey choice are discussed, noting that in some instances it may not be a choice at all.

Reliability and validity of a new instrument to measure tolerance of everyday risk for children.

BACKGROUND: A modicum of everyday risk provides opportunities for children to extend the limits of their competence. However, increasingly negative perceptions of risk have led to risk-averse behaviours in adults, including severely restricting children's play. The degree to which risk in play is tolerated by adults impacts on the lives and experiences of children. However, no measure of adult tolerance to everyday risk exists. The purpose of this study was to develop a valid and reliable instrument examining adults' tolerances of risk during children's play. METHODS: A 31-item survey of risk tolerance was developed based on a Norwegian model of risky play; 100 parents and teachers of children aged 3 to 13 years completed the instrument. Data were subjected to Rasch analysis. Psychometric properties of the data were examined. RESULTS: Iterative analyses produced an instrument with goodness of fit statistics in the acceptable range, a logical item hierarchy, person separation index >2 and reliability index of 0.87. There was a strong positive relationship between participants' self-perceived risk tolerance and scores on the instrument, and between the age of the child and scores on the instrument. CONCLUSIONS: The Tolerance of Risk in Play Scale (TRiPS) yields valid and reliable data for measuring the success of interventions to change adults' everyday risk beliefs, and for exploring the impact of adults' risk tolerance on children's play and development.

You are what you eat, whenever or wherever you eat it: an integrative analysis of fish food habits in Canadian and U.S.A. waters.

The degree to which fish diet differs by season and area, particularly over broad scales, was examined for the first time in temperate, contiguous north-west Atlantic Ocean waters by comparing food habit data for 10 species of fishes collected concurrently during the spring and autumn surveys in the U.S.A. (Gulf of Maine proper and Georges Bank) and in the summer survey in Canada (western Scotian Shelf and Bay of Fundy). For most species, there was a general concurrence among the three seasons and four areas: summer diets had the same dominant prey items as spring and autumn diets. Although a suite of multivariate analyses did elucidate some differences in specific proportions of the diet for these species across seasons and areas, the main prey did not substantially change for most of these species. These results suggest that there are (1) minimal differences in diet across season for these species at these taxonomic resolutions, (2) there are minimal differences in diet geographically for these species and (3) differences across species, as expected, are important. Many fisheries ecosystem and multispecies models are dependent on food habit data, where resolving seasonal and spatial differences in diet remains an important consideration; however, the present work implies that amalgamated estimates of diet from seasonal surveys may be a reasonable approach when no finer seasonal resolution exists, as long as due diligence is exercised.

Playfulness in children with and without disability: measurement and intervention.

OBJECTIVE: The differences in playfulness between young children with cerebral palsy and developmental delays and children who are typically developing, and the comparative effects of two interventions (one focused on improving mother-child interaction patterns, the other a neurodevelopmental treatment [NDT] session) on children's playfulness were examined in this study. Reliability and validity of the Test of Playfulness (ToP) also were examined. METHOD: Three trained raters used the ToP to score 38 children, half with cerebral palsy and developmental delays and half typically developing, as they played with their mothers. Mental ages of the children ranged from 3 to 18 months. The mother-child dyads in which the children had cerebral palsy and developmental delays were then randomly assigned to an intervention group. After a 1-hr intervention to improve mother-child interaction, the children were rescored on the ToP. RESULTS: After examination of ToP reliability and validity, children with cerebral palsy and developmental delays were found to score significantly lower on the ToP than their peers who were typically developing. In addition, children whose mothers received an intervention to improve mother-child interactions scored significantly higher on the ToP after intervention than before intervention. However, the gain scores of children whose mothers received the intervention were not significantly higher than those of children who received direct NDT. CONCLUSION: The results suggested that when the shared goal of parents and therapists is to enable children to express their inherent playfulness, intervention to improve parent-child interactions may be more potent than intervention directed at improving the child's developmental skills.

Prenatal detection and mapping of a distal 8p deletion associated with congenital heart disease.

We report the prenatal diagnosis, at 18 weeks' gestational age of a del(8)(p23.1-->pter) in a fetus with an atrio-ventricular canal, persistent left superior vena cava and hypoplastic right ventricle detected by sonographic imaging. We further refine the breakpoints associated with this defect using fluorescent in situ hybridization analysis (FISH). Our findings correlate with recent reports of the localization and importance of GATA4 (a zinc finger transcription factor) in cardiac development. Though microcephaly, mental retardation and typical behavioural features are well described in various deletions in 8p, the absence of notable microcephaly in this case raises the possibility for a separate genetic aetiology for some of these features. Indeed, primary autosomal recessive microcephaly (MCPH1) was recently mapped to a nearby region and may be the cause for this frequent observation in some cases of 8p deletions. These observations illustrate the role of FISH in prenatal diagnosis and refinement of chromosomal breakpoints. In addition, mappings of loci significant for cardiac development are presented. Our findings suggest that some features of the 8p deletion syndrome may ultimately be uncoupled from one another, and underscore the need for further study of this region of chromosome 8, in order to achieve adequate information for genetic counselling.

Assessment of play and leisure: delineation of the problem.

This paper discusses current perspectives on play and leisure and proposes that if play and leisure are to be accepted as viable occupations, then (a) valid and reliable measures of play must be developed, (b) interventions must be examined for inclusion of the elements of play, and (c) the promotion of play and leisure must be an explicit goal of occupational therapy intervention. Existing tools used by occupational therapists to assess clients' play and leisure are evaluated for the aspects of play and leisure they address and the aspects they fail to address. An argument is presented for the need for an assessment of playfulness, rather than of play or leisure activities. A preliminary model for the development of such an assessment is proposed.

The contribution of motor skills and playfulness to the play performance of preschoolers.

Consideration of a child's motor proficiency, intrinsic motivation, internal locus of control, and freedom to suspend many of the constraints of objective reality were proposed to provide a more comprehensive assessment of play than would an assessment of play performance alone. For empirical validation of this conceptual model of play, 29 subjects (15 nondisabled children and 14 children with juvenile rheumatoid arthritis) between the ages of 4 years 6 months and 6 years 6 months were given four assessments: (a) the Preschool Play Scale (Bledsoe & Shepherd, 1982, Knox, 1974); (b) the Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978); (c) the Preschool and Primary Internal-External Locus of Control Scale (Nowicki & Duke, 1974); and (d) tests of associative fluency (Wallach & Koogan, 1965; Ward, 1968). Multiple regression procedures revealed that, when considered together, scores on the Bruininks-Oseretsky Test of Motor Proficiency, tests of associative fluency, and the Preschool and Primary Internal-External Locus of Control Scale predicted scores on the Preschool Play Scale, thereby supporting the usefulness of the proposed theoretical model. Further, there was no significant difference in the mean scores of the two groups on the Preschool Play Scale. Although this finding may be an artifact of the small sample size, it also may support the authors' belief that children with motor impairments are able to compensate for their limitations by developing areas of relative strength that allow them to play normally. When this belief was further tested with Pearson product-moment correlations and Fisher's Z transformations, it was found that correlations between the test scores of the nondisabled children were not significantly different from those of the children with juvenile rheumatoid arthritis. Clearly, further research is needed.

Wrongful life and wrongful birth. Implications for diagnostic sonography.

We trust that this communication will further the understanding of the concepts involved in wrongful life and wrongful birth and will assist the conduct of medical practice in such a way to minimize risks to patients and ultrasound physicians with regard to their liability. When these physicians are involved in wrongful life cases, we believe that the concepts presented will assist them in understanding the legal and societal environment in which they find themselves. We hope also that this communication may assist the defense attorney to more effectively prepare a response to the plaintiff's legal theory. Knowledge should provide understanding, if not relief.

The effect of positioning on the hand function of boys with cerebral palsy.

The effect of positioning (sitting and prone standing) on the hand function of 10 boys (mean age = 12.5 years, SD = 1.2 years) with spastic diplegic cerebral palsy was studied. Two groups of subjects were tested twice (Tests 1 and 2) with the Jebsen-Taylor Hand Function Test (Jebsen, Taylor, Treischmann, Trotter, & Howard, 1969; Taylor, Sand, & Jebsen, 1973) to measure rate of manipulation. In addition, a scale modified from Hohlstein (1982) was used to measure quality of grasp on each subtest of the Jebsen-Taylor test. No significant differences between the mean scores of the two groups were found on the total scores of the Jebsen-Taylor test, either between Tests 1 and 2 or between sitting and prone standing. When the data from Tests 1 and 2 were combined, it was found that on one subtest--simulated feeding--the subjects performed significantly faster while in a prone standing position. On another subtest--picking up small objects--the subjects performed significantly faster while in a sitting position. Except during the simulated feeding subtest, the quality of the subjects' grasp was observed to be mature and tailored to the objects manipulated. This paper presents considerations for analyzing positioning in relation to upper extremity tasks.

Sterility in unsterilized surgical adhesive tape.

Providing a barrier to infectious organisms, sterile surgical adhesive tape has been used to close wounds for almost 20 years. The possibility that prepackaged unsterilized tape could be used for similar purposes is suggested by this study. Samples (480) were taken from 120 rolls that had been left in plastic surgical suite cabinets for 2 weeks. Aerobes and anaerobes were evaluated using tryptic soy agar with 5% sheep blood, while yeast and fungi were checked with Sabouraud dextrose agar. Sterility of sticky and smooth inner surfaces is shown to be a significant finding (p less than 0.01). It is concluded that prepackaged unsterilized surgical adhesive tape can be used to approximate wound edges without being a source of contamination (the sterile tape is 5600 percent more expensive). Wound closure in this manner would benefit the patient in the field, in the emergency room, or in third world countries where the supply of sterile tape is limited.

Sonographic diagnosis of partial hydatidiform mole.

We undertook a study to determine whether partial hydatidiform mole could be distinguished from other cases of first-trimester missed abortion using ultrasound. Scans from 22 cases of pathologically proved partial hydatidiform mole and 33 cases of first-trimester missed abortion were independently reviewed by three radiologists, each unaware of the final pathologic diagnosis. Using a standard data form, each radiologist recorded the dimensions, shape, and contents of the gestational sac, the sonographic appearance of the decidual reaction/placenta and myometrium, and the presence or absence of adnexal cysts. The following two criteria were found to be significantly associated (P less than .05) with the diagnosis of partial mole: 1) ratio of transverse to anteroposterior dimension of the gestational sac greater than 1.5, and 2) cystic changes, irregularity, or increased echogenicity in the decidual reaction/placenta or myometrium. There was high interobserver correlation for both criteria, as measured by the kappa statistic. In 50% of the cases, either both or neither of these criteria were met. When both criteria were met, the frequency of partial mole was 87%; when neither criterion was met, the frequency of missed abortion was 90%. These results indicate that ultrasound can be of value in predicting a high likelihood of partial mole prior to curettage.

The concepts of wrongful birth and wrongful life and their relation to medical imaging.

Although often used interchangeably, "wrongful birth" and "wrongful life" are distinct legal concepts. Wrongful birth involves the physician's duty to impart to expectant parents information about potential fetal defects. Wrongful life suits reflect the child's right to recovery for life-long suffering as a result of the physician's inadequate pre- or peri-natal care. Modern medical imaging techniques can play a major role in the diagnosis of interuterine malformations; this article explores the legal duties which may be imposed upon physicians who interpret such tests.