MYTHS AND FACTS ON HIPS IN CHILDREN WITH CEREBRAL PALSY

Reflections on this episode:

Professor Susan Stott is a Professor of paediatric orthopaedic surgery at the University of Auckland, New Zealand and paediatric orthopedic surgeon at Starship Children’s Hospital in New Zealand. 

Professor Stott was the second President of the AusACPDM and was the only New Zealand investigator on the NHMRC Centre for Research Excellence: Australasian Cerebral Palsy Clinical Trials Network hosted at University of Queensland. 

She is the clinical lead of the New Zealand CP register and on the reference group of the newly formed Neurodevelopmental Network, under the auspices of the Paediatric Society of New Zealand. She therefore has the ability to translate key research findings into clinical practice through strong alliances with key stake-holders within the health sector. 

In terms of general citation indices, her work has been cited 1546 times and h index 34. She has received the Gillies medal from the NZ Orthopaedic Assoc. for best paediatric orthopaedic research paper in 1998 and again in 2008. In 2018, she was the AusACPDM Transformative Practice Award Winner and also received the prestigious Presidential Award, New Zealand Orthopaedic Association

Prioritized strategies to improve diagnosis and early management of cerebral palsy for both Māori and non-Māori families

Sian A Williams, Ivana Nakarada-Kordic, Anna H Mackey, Stephen Reay, N Susan Stott

Abstract

Aim: To identify prioritized strategies to support improvements in early health service delivery around the diagnosis and management of cerebral palsy (CP) for both Māori and non-Māori individuals.

Method: Using a participatory approach, health care professionals and the parents of children with CP attended co-design workshops on the topic of early diagnosis and management of CP. Health design researchers facilitated two 'discovery' (sharing experiences and ideas) and two 'prototyping' (solution-focused) workshops in Aotearoa, New Zealand. A Māori health service worker co-facilitated workshops for Māori families.

Results: Between 7 and 13 participants (14 health care professionals, 12 parents of children with CP across all functional levels) attended each workshop. The discovery workshops revealed powerful stories about early experiences and needs within clinician-family communication and service provision. The prototyping workshops revealed priorities around communication, and when, what, and how information is provided to families; recommendations were co-created around what should be prioritized within a resource to aid health care navigation.

Interpretation: There is a critical need for improved communication, support, and guidance, as well as education, for families navigating their child with CP through the health care system. Further input from families and health care professionals partnering together will continue to guide strategies to improve health care service delivery using experiences as a mechanism for change.

Early otitis media puts children at risk for later auditory and language deficits

Abstract

Background: Otitis media is a common disorder of early childhood suspected of hindering auditory and language development, but evidence regarding these effects has been contradictory. To examine potential sources of these contradictory past results and explore in more detail the effects of early otitis media on auditory and language development, three specific hypotheses were tested: (1) Variability in children's general attention could influence results, especially for measures of auditory functioning, leading to spurious findings of group differences; (2) Different language skills may be differentially affected, evoking different effects across studies depending on skills assessed; and (3) Different mechanisms might account for the effects of otitis media on acquisition of different language skills, a finding that would affect treatment choices.

Method: Children 5-10 years old participated: 49 with and 68 without significant histories of otitis media. The auditory function examined was temporal modulation detection, using games designed to maintain children's attention; two additional measures assessed that attention. Measures of lexical knowledge and phonological sensitivity served as the language measures.

Results: Sustained attention was demonstrated equally across groups of children with and without histories of otitis media. Children with histories of otitis media performed more poorly than peers without those histories on the auditory measure and on both sets of language measures, but effects were stronger for phonological sensitivity than lexical knowledge. Deficits in temporal modulation detection accounted for variability in phonological sensitivity, but not in lexical knowledge.

Conclusion: When experimental factors are tightly controlled, evidence emerges showing effects of otitis media early in life on both auditory and language development. Mechanism of effects on language acquisition appear to involve both delayed auditory development and diminished access to the ambient language.

Keywords: Children; Language; Otitis media; Temporal processing.

A family-tailored early motor intervention (EMI-Heart) for infants with complex congenital heart disease: study protocol for a feasibility RCT

Elena Mitteregger, Tineke Dirks, Manuela Theiler, Oliver Kretschmar, Beatrice Latal

Abstract


Background: Children with congenital heart disease (CHD) undergoing open-heart surgery are at risk for developmental impairments with motor delay manifesting first and contributing to parental concerns. Only a few interventional studies aim to improve neuromotor development in infants with CHD with inconclusive results. We thus developed a family-tailored early motor intervention (EMI-Heart), which aims to promote motor development and family well-being in the first year of life after open-heart surgery. The primary aim described in this protocol is to evaluate feasibility of EMI-Heart. The secondary aim is to describe the difference between the intervention and control group in motor outcomes and family well-being at baseline, post-treatment, and follow-up.

Methods: This prospective, parallel single-center feasibility randomized controlled trial (RCT) will compare EMI-Heart with standard of care in infants with complex CHD. Sixteen infants and their families, randomly allocated to EMI-Heart or the control group, will participate within the first 5 months of life. Infants assigned to EMI-Heart will receive early motor intervention for 3 months. The intervention's key is to promote infants' postural control to enhance motor development and partnering with parents to encourage family well-being. Feasibility outcomes will be (a) clinical recruitment rate and percentage of families completing EMI-Heart, (b) average duration and number of sessions, and (c) acceptability of EMI-Heart using a parental questionnaire post-treatment, and descriptive acceptability of EMI-Heart to the pediatric physiotherapist. Secondary outcomes of the intervention and control group will be infants' motor outcomes and questionnaires assessing family well-being at 3-5 months (baseline), at 6-8 months (post-treatment), and at 12 months of age (follow-up). We will evaluate feasibility using descriptive statistics. Non-parametric statistical analysis of secondary outcomes will assess differences between the groups at baseline, post-treatment, and follow-up.

Discussion: This feasibility RCT will provide information about a newly developed family-tailored early motor intervention in infants with complex CHD. The RCT design will provide a foundation for a future large-scale interventional trial for infants with CHD after open-heart surgery.

Keywords: Congenital heart disease; Early motor intervention; Family well-being; Family-tailored intervention; Neuromotor development; Open-heart surgery; Parental and child health-related quality of life; Physiotherapy.

EMERGENCE OF THE CORTICAL ENCODING OF PHONETIC FEATURES IN THE FIRST YEAR OF LIFE

Giovanni M. Di Liberto, Adam Attaheri, Giorgia Cantisani, Richard B. Reilly, Áine Ní Choisdealbha, Sinead Rocha, Perrine Brusini & Usha Goswami   

Nature Communications volume 14, Article number: 7789 (2023)   

Abstract  

Even prior to producing their first words, infants are developing a sophisticated speech processing system, with robust word recognition present by 4–6 months of age.   

These emergent linguistic skills, observed with behavioural investigations, are likely to rely on increasingly sophisticated neural underpinnings. The infant brain is known to robustly track the speech envelope, however previous cortical tracking studies were unable to demonstrate the presence of phonetic feature encoding.  

Here we utilise temporal response functions computed from electrophysiological responses to nursery rhymes to investigate the cortical encoding of phonetic features in a longitudinal cohort of infants when aged 4, 7 and 11 months, as well as adults.   

The analyses reveal an increasingly detailed and acoustically invariant phonetic encoding emerging over the first year of life, providing neurophysiological evidence that the pre-verbal human cortex learns phonetic categories. By contrast, we found no credible evidence for age-related increases in cortical tracking of the acoustic spectrogram.

“Chemical analysis of fresh and aged Australian e-cigarette liquids” 
published in the Medical Journal of Australia 

“Electronic cigarette usage patterns and perceptions in adult Australians” 
published in Toxics in 2023.

Chemical analysis of fresh and aged Australian e-cigarette liquids

Alexander Larcombe, Sebastien Allard, Paul Pringle, Ryan Mead-Hunter, Natalie Anderson, Benjamin Mullins

Affiliations expand

• PMID: 34528266
• DOI: 10.5694/mja2.51280

Abstract

Objectives: To assess the chemical composition of electronic cigarette liquids (e-liquids) sold in Australia, in both their fresh and aged forms.

Design, setting: Gas chromatography-mass spectrometry analysis of commercial e-liquids sold in Australia (online and physical stores).

Main outcome measures: Chemical composition of 65 Australian e-liquids - excipients/solvents, flavouring chemicals, other known e-liquid constituents (including nicotine), and polycyclic aromatic hydrocarbons - before and after an accelerated ageing process that simulated the effects of vaping.

Results: The measured levels of propylene glycol and glycerol often diverged from those recorded on the e-liquid label. All e-liquids contained one or more potentially harmful chemicals, including benzaldehyde, menthol, trans-cinnamaldehyde, and polycyclic aromatic hydrocarbons. Nicotine or nicotyrine were detected in a small proportion of e-liquids at extremely low concentrations.

Conclusions: Australian e-liquids contain a wide variety of chemicals for which information on inhalation toxicity is not available. Further analyses are required to assess the potential long term effects of e-cigarette use on health.

Electronic Cigarette Usage Patterns and PErceptions in Audult Australians

Abstract (abbreviated)

In this study, we screened 2217 adult Australians with the aim of assessing these questions in a sample of current or former e-cigarette users. A total of 505 out of 2217 respondents were current or former e-cigarette users, with only these respondents completing the full survey. 

Key findings of this survey included the high proportion of respondents who indicated they were currently using e-cigarettes (307 out of 2217 = 13.8%), and the high proportion of current e-cigarette users that were also smokers (74.6%). The majority of respondents used e-liquids containing nicotine (70.3%), despite it being illegal in Australia without a prescription, and the majority bought their devices and liquids in Australia (65.7%). 

A significant proportion of current e-cigarette users (30.6%) thought that e-cigarettes were completely safe to use long-term, although in general, there was a large amount of uncertainty/ambivalence with respect to perceptions of e-cigarette safety and efficacy as smoking cessation tools. 

This study shows that e-cigarette use is common in Australia, and that appropriate dissemination of unbiased research findings on their safety and efficacy in smoking cessation is urgently required.

Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

Alexandra D W Sullivan, Anne K Bozack, Andres Cardenas, Jonathan S Comer, Daniel M Bagner, Rex Forehand, Justin Parent

Affiliations expand

• PMID: 37733001
• PMCID: PMC10626625 (available on 2024-09-21)
• DOI: 10.1177/09567976231194221

Abstract

This study examined whether children exposed to adversity would exhibit lower epigenetic age acceleration in the context of improved parenting. Children with developmental delays and externalizing behavior problems (N = 62; Mage = 36.26 months; 70.97% boys, 29.03% girls; 71% Latinx, 22.6% Black) were drawn from a larger randomized controlled trial (RCT), which randomized them to receive Internet-delivered parent-child interaction therapy (iPCIT; n = 30) or community referrals as usual (RAU; n = 32).

Epigenetic age acceleration was estimated with the pediatric buccal epigenetic clock, using saliva.

Adversity was assessed using parent, family, and neighborhood-level cumulative-risk indicators.

Adversity interacted with Time 2 (T2) observations of positive and negative-parenting practices to predict epigenetic age acceleration 1.5 years later, regardless of treatment assignment. Children exposed to more adversity displayed lower epigenetic age acceleration when parents evidenced increased positive (b = -0.15, p = .001) and decreased negative (b = -0.12, p = .01) parenting practices.

Implementation of an Integrated Knowledge to Action strategy can be used to implement the clinical guidelines for the early detection of cerebral palsy in a state-wide early intervention service and the impact of social determinants of health on service engagement.

In this retrospective longitudinal cohort study that was completed in Western Australia’s tertiary paediatric early intervention service, knowledge translation strategies which included consumer  perspectives, clinician training and communities of practices guided implementation.

With referral number and age, delivery of early detection and intervention following the implementation of the guidelines, it was found that the implementation strategies were effective in reducing referral age with improved delivery of early detection assessments.

This has some very important implications on both short and long term health outcomes.

*********

Sue Anne Davidson is the Manager of Kids Rehab WA at the Perth Children’s Hospital and a PhD candidate at Curtin University. She has over 15 years experience in the design, implementation, and evaluation of tertiary paediatric rehabilitation services at PCH.

Sue-Anne’s experience in clinical, management and leadership has enabled her to lead improvements within the tertiary hospital setting to improve accessible, equitable and sustainable services for children and adolescents in WA. 

She has served on several committees including the Disability Health Network’s Executive Advisory group and the WA Sustainable Health Review Clinical Reference Group. She is now the Co-Chair of the Child and Adolescent Health Service Disability Access and Inclusion Committee. 

Sue-Anne has a Masters in Health Administration and is a PhD candidate with her studies focusing on the development of a state-wide early detection network for children at high risk of CP and neurodevelopmental disability, linked to national and international best practice models.

Including a relationship-focus in paediatric occupational therapy interventions: Introducing the PAIR Model

The importance of parent-child relationships for child developmental outcomes suggests a need to incorporate a relationship focus into early intervention programs for children with developmental delays. 

Nevertheless, confusion exists about the definition and application of relationship-focussed interventions, and occupational therapists remain more developmentally- and child-focussed. 

There is a need to operationalize relationship-focussed interventions to make these approaches clinically accessible. This report defines, and provides a rationale for, including parent-child relationship-focussed interventions in early childhood occupational therapy interventions. 

A new conceptual model, the “Phased Approach to Incorporating a Relationship-focus” (PAIR), is detailed for consideration in pediatric therapy settings. The PAIR model can support professional education, inform practice, and guide future research regarding relationship-focussed interventions. 

Research is needed to test the usefulness of this model in occupational therapy practice.

The potential of cell therapies for cerebral palsy: where are we today?

Iona Novak, Madison Cb Paton, Alexandra R Griffin, Michelle Jackman, Remy K Blatch-Williams, Megan Finch-Edmondson

• PMID: 37428111
• DOI: 10.1080/14737175.2023.2234642

No abstract available

Keywords: Cerebral palsy; efficacy; inflammation; mesenchymal stem cells; safety; stem cells; umbilical cord blood.

Professor Novak is the Cerebral Palsy Alliance Chair of Allied Health, and co-founder of the Cerebral Palsy Alliance Research Institute, affiliated with the Brain and Mind Centre and Faculty of Medicine and Health at The University of Sydney.

Building a clinical researcher’s career - lessons from a mentor

Professor Elliott is the Director of Research at Telethon Kids Institute, the Chair of Kids Rehab at Child Adolescent Health Services (CAHS) and a Professor in the School of Allied Health at Curtin University.

Live from the Small Steps | BIG Impact 2023 Conference!

The art of Science Communication.

Season 3 Wrap Up

Final episode of the season?!?

As Ash and Dayna reflect on this incredible year, we pull together some key themes of the episodes and the ever so wonderful and brilliant guests we have had on the show. We are so grateful for all of the researchers who so generously gave their time to help spread the word on the current state of science in the field. We have learnt so much and we hope you have had some great takeaways too!

In true Ash style, the qualitative researcher in her couldn’t help but to carry out a thematic analysis of the episodes in 2023. We love that she did that though - you can see the transdiagnostic approach really set in because of the common themes that run through so many different areas. We truly believe that if you can grasp all of the themes of the episodes this year, you can so easily translate this knowledge into your practice - staying up to date with the latest and waiting ever so hopefully for more to come. 

In this episode, we talk about the powerhouses of the industry who joined us on the show. They are thought provokers for sure - titans of the industry with years of experience, extensive global collaborations and wisdom to impart to clinicians and researchers alike. These researchers include Professor Peter Rosenbaum, Professor Diane Damiano, Professor Andrew Whitehouse, Professor Mark Belgrove and Professor Laurent Servais and of course some of our returning guests which include Professor Ben Jackson, Dr Bhooma Aravamuthan, Dr Ros Ward and Ginny Paleg just to name a few. All of their messaging was around the importance of the ‘F-words’!  

We as health professionals need to “be humble” as Bhooma so eloquently described and the real importance of being person centred was a common theme. Starting the season with Emily Prior and later Connor Johnstone truly reinforced this - both incredible young people with lived experience. It always comes down to the consumers and what a compelling reason to bring forth evidence based interventions and approaches. Their lives matter, their dreams matter - and again, the ‘F-words’ framework brings that home.

We loved our conversations with other thought provokers such as Associate Professor Daniel Navon regarding the sociological take on genetic testing (who asked us more questions then we of him!) and most recently Dr Jessica Stokes-Parish on the world of misinformation, disinformation and the value of debunking! (remember the CRABs mnemonic!)

Then there was the whole theme of brain activation and mobility - we loved talking about the functional MRI results with Dr Yannick Bleyenhueff and that self-initiation is vital! More than just the talk about dosage and the number of hours children engage in therapy - it is about ensuring that the right ingredients are in the intervention. This led nicely into a little series with Andrina Sabet, Dr Heather Feldner and Dr Sam Logan on mobility as a human right. For Dayna, as a clinician, this whole area was incredibly exciting. We now have these papers to reference and use as a resource when we have to advocate for change.

Then we just talked about our highlights and what a highlight reel too! Going international and bringing the podcast to EACD in Slovenia was an amazing experience. We loved meeting so many people and the opportunity to help bring their work into the broader community. 

Also, our very first Minister visit with the Honourable Bill Shorten was a highlight for sure. The clinic and our studio was a hive of activity and it was so encouraging to hear the Minister describe the value of evidence based practice and that it is be the way forward for a sustainable scheme.

That was 2023! We are so excited for what 2024 holds! We look forward to meeting more of you at EACD in Bruge and AusACPDM in Cairns in 2024. Have a wonderful holiday season and we will talk to you again soon!

Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet

Jessica Stokes-Parish

Free PMC article

Abstract

Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. 

This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic.

Keywords: COVID-19; critical appraisal; digital literacy; health literacy; infodemic; infodemiology; misinformation; online health; science communication; social media.

Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants

List of authors.

• Beate Kampmann, M.D., Ph.D., 
• Shabir A. Madhi, M.B., B.Ch., Ph.D., 
• Iona Munjal, M.D., 
• Eric A.F. Simões, M.D., 
• Barbara A. Pahud, M.D., M.P.H., 
• Conrado Llapur, M.D., 
• Jeffrey Baker, M.D., 
• Gonzalo Pérez Marc, M.D., 
• David Radley, M.S., 
• Emma Shittu, Ph.D., 
• Julia Glanternik, M.D., 
• Hasra Snaggs, M.D., 
• et al.,
•  for the MATISSE Study Group*

Abstract

BACKGROUND

Whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV)–associated lower respiratory tract illness in newborns and infants is uncertain.

METHODS

In this phase 3, double-blind trial conducted in 18 countries, we randomly assigned, in a 1:1 ratio, pregnant women at 24 through 36 weeks’ gestation to receive a single intramuscular injection of 120 μg of a bivalent RSV prefusion F protein–based (RSVpreF) vaccine or placebo. The two primary efficacy end points were medically attended severe RSV-associated lower respiratory tract illness and medically attended RSV-associated lower respiratory tract illness in infants within 90, 120, 150, and 180 days after birth. A lower boundary of the confidence interval for vaccine efficacy (99.5% confidence interval [CI] at 90 days; 97.58% CI at later intervals) greater than 20% was considered to meet the success criterion for vaccine efficacy with respect to the primary end points.

RESULTS

At this prespecified interim analysis, the success criterion for vaccine efficacy was met with respect to one primary end point. Overall, 3682 maternal participants received vaccine and 3676 received placebo; 3570 and 3558 infants, respectively, were evaluated. Medically attended severe lower respiratory tract illness occurred within 90 days after birth in 6 infants of women in the vaccine group and 33 infants of women in the placebo group (vaccine efficacy, 81.8%; 99.5% CI, 40.6 to 96.3); 19 cases and 62 cases, respectively, occurred within 180 days after birth (vaccine efficacy, 69.4%; 97.58% CI, 44.3 to 84.1). 

Medically attended RSV-associated lower respiratory tract illness occurred within 90 days after birth in 24 infants of women in the vaccine group and 56 infants of women in the placebo group (vaccine efficacy, 57.1%; 99.5% CI, 14.7 to 79.8); these results did not meet the statistical success criterion. No safety signals were detected in maternal participants or in infants and toddlers up to 24 months of age. The incidences of adverse events reported within 1 month after injection or within 1 month after birth were similar in the vaccine group (13.8% of women and 37.1% of infants) and the placebo group (13.1% and 34.5%, respectively).

CONCLUSIONS

RSVpreF vaccine administered during pregnancy was effective against medically attended severe RSV-associated lower respiratory tract illness in infants, and no safety concerns were identified. 

F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review

Ana Carolina De Campos, Álvaro Hidalgo-Robles, Egmar Longo, Claire Shrader, Ginny Paleg

Abstract

Aim: To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions.

Method: Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location.

Results: Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant.

Interpretation: Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice.

A roundtable discussion about the clinical application of Mobility as a Human Right!

Mobility is a fundamental human right and is supported by the United Nations and the ON Time Mobility framework.

W Logan, Bethany M Sloane, Lisa K Kenyon, Heather A Feldner 

PMID: 37232636 
PMCID: PMC10215286 
DOI: 10.3390/bs13050399 

Free PMC article 

Abstract 

Mobility is a fundamental human right and is supported by the United Nations and the ON Time Mobility framework. The purpose of this study was to understand the effect of a powered mobility intervention on developmental changes of children with cerebral palsy (CP). 

This study was a randomized, crossover clinical trial involving 24 children (12-36 months) diagnosed with CP or with high probability of future CP diagnosis based on birth history and current developmental status. Children received the Explorer Mini and a modified ride-on car in randomized order, each for 8 weeks. 

The Bayley Scales of Infant and Toddler Development-4th Edition was administered at baseline, mid-study, and end-of-study. Raw change scores were used for analysis. 

Total minutes of use per device was categorised as low or high use for analysis based on caregiver-reported driving diaries. 

Explorer Mini: The high use group exhibited significantly greater positive change scores compared to the low use group on receptive communication, expressive communication, and gross motor sub scales (p less than 0.05). 

Modified ride-on car: No significant differences between low and high use groups. Regardless of device, low use was associated with no significant developmental change and high use was associated with positive developmental changes. Mobility access is critical to maximize the development of children with CP and may be augmented by using powered mobility devices. 

Results may have implications for the development of evidence-based guidelines on dosage for powered mobility use. 

Keywords: cerebral palsy; disability; mobility; technology.

Powered Mobility Device Use and Developmental Change of Young Children with Cerebral Palsy

Mobility is a fundamental human right and is supported by the United Nations and the ON Time Mobility framework.

The purpose of this study was to understand the effect of a powered mobility intervention on developmental changes of children with cerebral palsy (CP).

This study was a randomized, crossover clinical trial involving 24 children (12-36 months) diagnosed with CP or with high probability of future CP diagnosis based on birth history and current developmental status. Children received the Explorer Mini and a modified ride-on car in randomized order, each for 8 weeks. The Bayley Scales of Infant and Toddler Development-4th Edition was administered at baseline, mid-study, and end-of-study. Raw change scores were used for analysis. Total minutes of use per device was categorized as low or high use for analysis based on caregiver-reported driving diaries.

Explorer Mini: The high use group exhibited significantly greater positive change scores compared to the low use group on receptive communication, expressive communication, and gross motor subscales (p < 0.05). 

Modified ride-on car: No significant differences between low and high use groups. Regardless of device, low use was associated with no significant developmental change and high use was associated with positive developmental changes. 

Mobility access is critical to maximize the development of children with CP and may be augmented by using powered mobility devices. 

Results may have implications for the development of evidence-based guidelines on dosage for powered mobility use.

ON Time Mobility: Advocating for Mobility Equity

Abstract

Mobility is a human right. The traditional definition of mobility in physical therapy practice is centered on translocation and, while accurate, is not comprehensive. 

In this article, we propose the ON Time Mobility framework: that all children have the right to be mobile throughout their development to explore, engage in relationships, and develop agency to cocreate their lives. 

This perspective highlights interconnected principles of timing, urgency, multimodal, frequency, and sociability to begin discussions on supporting the right to hours of active mobility each day for all children. 

We propose critical evaluation and discussion of these principles followed by a call to action to shift our conceptualization and enactment of mobility. 

This mobility rights perspective challenges current medical systems, industry, and government to collaborate with children with disabilities, their families and communities to support mobility as a source of physical and social interactions that define and develop individuals 

(see Supplemental Digital Content 1, the Video Abstract, available at: http://links.lww.com/PPT/A398 ).

Brain activation changes following motor training in children with unilateral cerebral palsy: An fMRI study

Rodrigo Araneda, Laurance Dricot, Daniela Ebner-Karestinos, Julie Paradis, Andrew M Gordon, Kathleen M Friel, Yannick Bleyenheuft

Free article

Abstract

Background: Intensive motor-learning-based interventions have demonstrated efficacy for improving motor function in children with unilateral spastic cerebral palsy (USCP). Although this improvement has been associated mainly with neuroplastic changes in the primary sensori-motor cortices, this plasticity may also involve a wider fronto-parietal network for motor learning.

Objective: To determine whether hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) induces brain activation changes in an extensive network for motor skill learning and whether these changes are related to functional changes observed after HABIT-ILE.

Methods: In total, 25 children with USCP were behaviourally assessed in manual dexterity and everyday activities before and after HABIT-ILE. Functional imagery monitored brain activity while participants manipulated objects using their less-affected, more-affected or both hands. Two random-effects-group analyses performed at the whole-brain level assessed the brain activity network before and after therapy. Three other random-effects-group analyses assessed brain activity changes after therapy. Spearman's correlations were used to evaluate the correlation between behavioural and brain activity changes.

Results: The same fronto-parietal network was identified before and after therapy. After the intervention, the more-affected hand manipulation elicited a decrease in activity on the motor cortex of the non-lesional hemisphere and an increase in activity on motor areas of the lesional hemisphere. The less-affected hand manipulation generated a decrease in activity of sensorimotor areas in the non-lesional hemisphere. Both-hands manipulation elicited an increase in activity of both hemispheres. Furthermore, we observed an association between brain activity changes and changes in everyday activity assessments.

Conclusion: Brain activation changes were observed in a fronto-parietal network underlying motor skill learning with HABIT-ILE in children with USCP. Two different patterns were observed, probably related to different phases of motor skill learning, representing an increased practice-dependent brain recruitment or a brain activation refinement by more efficient means. CLINICALTRIALS.GOV: NCT01700777 &NCT02667613.

Keywords: Cerebral palsy; FMRI; HABIT-ILE; Intensive therapy; Neuroplasticity.

It has been an incredible week for the podcast this week. A quick debrief with Ash and Dayna and a look ahead to some exciting new epsiodes!

The NDIS (National Disability Insurance Scheme) and evidence based practice.

A very special ResearchWorks episode as we speak with (Australian) Federal Minister Bill Shorten - the Minister for the National Disability Insurance Scheme (the NDIS). 

The NDIS is a very unique Australian treasured, national health care service - there may be no other equivalent of it's kind in the world and though it has had it's share of critics, the NDIS is ever changing and adapting to the needs of Australian families - old and young alike.

The discussion over the NDIS and evidence based practices is at a crossroads and under the stewardship of Minister Bill Shorten, there is a galvanised effort to bring evidence based practices and research to the fore.

The Healthy Strides Foundation was proud to host the Minister as the Foundation is an  unequivocal supporter of merging evidence and research into the clinical environment.

We hope you enjoy the mini-episode. It is exciting to note what the future holds for research and evidence fused clinical practices and how the NDIS fits into this model. A very nice blueprint that goes beyond the borders of Australia and is food for thought for every clinician and researcher throughout the developed world. 

Persuasion and Communication in Sport, Exercise, and Physical Activity

How can we use persuasion methods to make people more physically active and improve their sport and exercise experiences? 

How can instructors, coaches, athletes, and practitioners most effectively communicate their messages to others? Persuasion and Communication in Sport, Exercise, and Physical Activity is the first book to consider the applications of persuasion frameworks within activity-related contexts, whilst also summarising the major developments relating to communication topics in these settings. 

It provides a state of the art review of the key developments, challenges, and opportunities within the field. It brings together international experts from the fields of social, health, and sport and exercise psychology, to give theoretical overviews, insights into contemporary research themes and practical implications, as well as agendas for future research. 

Covering topics such as changing attitudes towards exercise, social influence, persuasive leadership and communicating with people with physical disabilities, this book provides a contemporary approach to persuasion and communication in a sport, exercise and physical activity setting. 

It is an important text for upper-level undergraduate and postgraduate students, as well as academics in the fields of Sport and Exercise Science, Kinesiology, Health and Physical Activity Promotion and related areas of Psychology.

https://www.researchgate.net/publication/316698536_Persuasion_and_Communication_in_Sport_Exercise_and_Physical_Activity

https://www.routledge.com/Persuasion-and-Communication-in-Sport-Exercise-and-Physical-Activity/Jackson-Dimmock-Compton/p/book/9780367407759

Eye movements and stress during eye-tracking gaming performance in children with dyskinetic cerebral palsy

Saranda Bekteshi, Petra Karlsson, Lieselot De Reyck, Karen Vermeerbergen, Marco Konings, Patrick Hellin, Jean-Marie Aerts, Hans Hallez, Bernard Dan, Elegast Monbaliu

Affiliations expand

• PMID: 35393636
• DOI: 10.1111/dmcn.15237

Abstract

Aim: This study aimed to explore eye movements and stress during eye-tracking gaming performance in children with dyskinetic cerebral palsy (CP) compared with typically developing children, and associations between eye-tracking performance, eye movements, stress, and participants' characteristics.

Method: This cohort study included 12 children with dyskinetic CP aged 5 to 12 years (mean age 8 years 7 months, standard deviation [SD] 2 years 3 months) and 23 typically developing children aged 5 to 13 years (mean age 9 years 0 months, SD 2 years 7 months). Participants played 10 eye-tracking games. Tobii X3-120 and Tobii Pro Lab were used to record and analyse eye movements. Stress was assessed through heart rate variability (HRV), recorded during rest, and eye-tracking performance using the Bittium Faros360° ECG Holter device. Eye-tracking performance was measured using gaming completion time. Fixation and saccade variables were used to quantify eye movements, and time- and frequency-domain variables to quantify HRV. Non-parametric statistics were used.

Results: Gaming completion time was significantly different (p < 0.001) between groups, and it was negatively correlated with experience (rs = -0.63, p = 0.029). No significant differences were found between groups in fixation and saccade variables. HRV significantly changed from rest to eye-tracking performance only in typically developing children and not in children with dyskinetic CP.

Interpretation: Children with dyskinetic CP took longer to perform the 10 games, especially the inexperienced users, indicating the importance of the early provision of eye-tracking training opportunities. It seems that eye-tracking tasks are not a source of increased stress and effort in children with dyskinetic CP.

What this paper adds: Participants with dyskinetic cerebral palsy (CP) took twice as long to perform 10 eye-tracking games than typically developing peers. Participants with dyskinetic CP with previous eye-tracking experience performed the games faster. Fixation and saccade variables were not significantly different between children with and without dyskinetic CP. Heart rate variability showed no differences between rest and performance in participants with dyskinetic CP. Gross Motor Function Classification System, Manual Ability Classification System, and Viking Speech Scale levels were not correlated to the eye movements or stress variables.

Reliability and Validity of the Youth and Young-Adult Participation and Environment Measure (Y-PEM): An Initial Evaluation

Saeideh Shahin, Sara Ahmed, Briano DiRezze, Dana Anaby

Abstract

Aim: To examine psychometric properties and aspects of utility of the Youth and young-adult Participation and Environment Measure (Y-PEM).

Methods: Young people with and without physical disabilities (n = 113) aged 12 to 31 (x¯ = 23; SD = 4.3) completed an online survey containing the Y-PEM and QQ-10 questionnaire. To examine construct validity, differences in participation levels and environmental barriers/facilitators were examined between those with (n = 56) and without disabilities (n = 57) via t-test. Internal consistency was computed using Cronbach's alpha. To examine test-retest reliability, a sub-sample of 70 participants completed the Y-PEM a second time, 2-4 weeks apart. The Intraclass correlation coefficient (ICC) was calculated.

Results: Descriptively, participants with disabilities had lower levels of frequency and involvement across all four settings: home, school/educational, community, workplace. Internal consistency were 0.71 and above (up to 0.82) across all scales with the exception of home (0.52) and workplace frequency (0.61). Test-retest reliability were 0.70 and above (up to 0.85) across all settings except for environmental supports at school (0.66) and workplace frequency (0.43). Y-PEM was perceived as a valuable tool with relatively low burden.

Conclusions: Initial psychometric properties are promising. Findings support Y-PEM's use as a feasible self-reported questionnaire for individuals aged 12-30 years old.

Keywords: Assessment; environment; participation measure; transition-aged; workplace participation.