Functional Abilities Of Children Research Articles

Functional abilities of children with cerebral palsy

Introduction. Cerebral palsy is one of the leading causes of neurological impairment in childhood. The dominant clinical sign is the impairment of gross motor functions; however, associated conditions may limit the child with cerebral palsy in daily activities as well. The aim of this study was to determine the functional status of children with cerebral palsy, its relationship with the types of cerebral palsy, and concomitant conditions. Material and Methods. The sample included 206 children with cerebral palsy. The data were obtained from medical records with clinical characteristics of cerebral palsy, and associated conditions. The clinical types of cerebral palsy were determined using the Surveillance of Cerebral Palsy in Europe registry and topographical categories. Gross motor function abilities were evaluated using the Gross Motor Function Classification System and manual abilities by the Manual Ability System Classification. Results. According to the Gross Motor Function Classification System, about two thirds of children with cerebral palsy (64.0%) had levels I, II or III of gross motor function impairment. A statistically significant difference was noted with respect to the distribution of various clinical types of cerebral palsy in relation to functional classification based on Gross Motor Function Classification System (p < 0.001), as well as in the functional classification in terms of intellectual impairment (p <0.001); children with severe forms of intellectual impairment were classified at a higher level of functional limitation. Epilepsy was more prevalent in children with higher level of functional limitation (p = 0.009). Conclusion. Two thirds of children with cerebral palsy could walk independently or with walking aids. Children with quadriplegia and dyskinetic type of cerebral palsy had the most limited functional abilities. Associated conditions were more prevalent in children with higher functional limitations.

Environmental impact on young children's participation in home-based activities.

AimTo test the effect of child, family, and environmental factors on young children's participation in home‐based activities.MethodCaregivers of young children were recruited using convenience and snowball sampling. Participants were 395 caregivers of children (222 males, 173 females) aged from 1 month to 5 years and 11 months. Demographic items and the home section of the Young Children's Participation and Environment Measure were administered online, followed by completion of the daily activities, mobility, and social/cognitive domains of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test by telephone interview.ResultsA structural equation model fitted the data well (comparative fit index=0.91) and explained 31.2% of the variance in perceived environmental support and 42.5% of the variance in home involvement. Functional limitations and performance had an indirect effect on young children's participation through their effect on perceived environmental support. Specifically, fewer functional limitations and higher task performance were associated with greater environmental support, which in turn predicted higher levels of home involvement.InterpretationResults suggest the importance of a young child's functional abilities and task performance on caregiver perceptions of environmental support at home, and the impact of environmental support on a child's participation in home‐based activities during the early childhood period. Results warrant replication with more diverse samples to evaluate model generalizability.

Multiprofessional evaluation in clinical practice: establishing a core set of outcome measures for children with cerebral palsy

To develop a national consensus on outcome measures that define functional ability in children with cerebral palsy (CP) according to the International Classification of Functioning, Disability and Health (ICF) framework. The project started in 2008 in neuropaediatric units of two university hospitals and one outpatient clinic. Each professional group selected representatives to be knowledge brokers for their own specialty. Based on the evidence, expert opinion, and the ICF framework, multiprofessional teams selected the most valid measures used in clinical practice (2009-2010). Data from 269 children with CP were analysed, classified by the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System, and evaluated. The process aimed at improving and unifying clinical practice in Finland through a national consensus on the core set of measures. The selected measures were presented by professional groups, and consensus was reached on the recommended core set of measures to be used in all hospitals treating children with CP in Finland. A national consensus on relevant and feasible measures is essential for identifying differences in the effectiveness of local practices, and for conducting multisite intervention studies. This project showed that multiprofessional rehabilitation practices can be improved through respect for and inclusion of everyone involved.

Environmental Impact on Young Children's Participation in Home-Based Activities

Aim To test the effect of child, family, and environmental factors on young children's participation in home-based activities. Method Caregivers of young children were recruited using convenience and snowball sampling. Participants were 395 caregivers of children (222 males, 173 females) aged from 1 month to 5 years and 11 months. Demographic items and the home section of the Young Children's Participation and Environment Measure were administered online, followed by completion of the daily activities, mobility, and social/cognitive domains of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test by telephone interview. Results A structural equation model fitted the data well (comparative fit index=0.91) and explained 31.2% of the variance in perceived environmental support and 42.5% of the variance in home involvement. Functional limitations and performance had an indirect effect on young children's participation through their effect on perceived environmental support. Specifically, fewer functional limitations and higher task performance were associated with greater environmental support, which in turn predicted higher levels of home involvement. Interpretation Results suggest the importance of a young child's functional abilities and task performance on caregiver perceptions of environmental support at home, and the impact of environmental support on a child's participation in home-based activities during the early childhood period. Results warrant replication with more diverse samples to evaluate model generalizability.

The Effects of Visual Biofeedback Balance Training on Functional Ability in Children with Cerebral Palsy : A Pilot Study

The Effects of Visual Biofeedback Balance Training on Functional Ability in Children with Cerebral Palsy : A Pilot Study

Functional abilities in children and adults with the CDKL5 disorder.

Functional abilities in the CDKL5 disorder have been described as severely impaired, yet some individuals are able to run and use phrases for speech. Our study investigated gross motor, hand function, and expressive communication abilities in individuals with the CDKL5 disorder. Data for 108 females and 16 males registered with the International CDKL5 disorder database and with a pathogenic CDKL5 mutation were analyzed. Relationships between functional abilities, age, genotype, and gender were analyzed using regression models. Over half of the females could sit on the floor and nearly a quarter could walk 10 steps. Fewer males could complete these tasks although one boy was able to sit, walk, and run. Most females and few males were able to pick up a large object. Females mostly used gestures to communicate while males mostly used other forms of non-verbal communication. Compared to those with no functional CDKL5 protein, individuals with truncating variants after aa 781 were more likely to be able to stand (OR 5.7, 95%CI 1.2, 26.6) or walk independently (4.3, 95%CI 0.9, 20.5), and use more advanced communication methods such as words (OR 6.1, 95%CI 1.5-24.2). Although abilities were markedly impaired for the majority with the CDKL5 disorder, some females and a few males had better functional abilities. This variability may be related to underlying gene variants, with females with a late truncating variant having better levels of ability than those with no functional protein. © 2016 Wiley Periodicals, Inc.

Relationship Between Executive Functioning and Symptoms of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in 6-8Year Old Children.

This study examined relationships between executive functioning (EF) and ADHD/ASD symptoms in 339 6-8year-old children to characterise EF profiles associated with ADHD and ADHD+ASD. ADHD status was assessed using screening surveys and diagnostic interviews. ASD symptoms were measured using the Social Communication Questionnaire, and children completed assessments of EF. We found the EF profile of children with ADHD+ASD did not differ from ADHD-alone and that lower-order cognitive skills contributed significantly to EF. Dimensionally, ASD and inattention symptoms were differentially associated with EF, whereas hyperactivity symptoms were unrelated to EF. Differences between categorical and dimensional findings suggest it is important to use both diagnostic and symptom based approaches in clinical settings when assessing these children's functional abilities.

Relation Between Core-stability and Functional Abilities in Children with Spastic Cerebral Palsy

Relation Between Core-stability and Functional Abilities in Children with Spastic Cerebral Palsy

The effects of hippotherapy on postural balance and functional ability in children with cerebral palsy.

[Purpose] This study evaluated the effects of hippotherapy on seated postural balance, dynamic balance, and functional performance in children with cerebral palsy and compared the effects of 12 and 24 sessions on seated postural balance. [Subjects and Methods] This study included 15 children with cerebral palsy aged between 5 and 10 years. Interventions: A hippotherapy protocol was performed for 30 minutes, twice a week, for 12 weeks. Postural balance in a sitting position was measured using an AMTI AccuSway Plus force platform 1 week before initiating the hippotherapy program and after 12 and 24 weeks. The Berg Balance Scale (BBS) and Pediatric Evaluation of Disability Inventory (PEDI) were used before and after 24 sessions. [Results] Significant differences were observed for center of pressure (COP) variables, including medio-lateral (COPml), anteroposterior displacement (COPap), and velocity of displacement (VelCOP), particularly after 24 sessions. There were also significant differences in BBS scores and PEDI score increases associated with functional skills (self-care, social function, and mobility), caregiver assistance (self-care), social function, and mobility. [Conclusion] Hippotherapy resulted in improvement in postural balance in the sitting position, dynamic balance, and functionality in children with cerebral palsy, an effect particularly significant after 24 hippotherapy sessions.

Muscle growth is reduced in 15-month-old children with cerebral palsy.

Lack of muscle growth relative to bone growth may be responsible for development of contractures in children with cerebral palsy (CP). Here, we used ultrasonography to compare growth of the medial gastrocnemius muscle in children with and without CP. Twenty-six children with spastic CP (15 males, 11 females; mean age 35mo, range 8-65mo) and 101 typically developing children (47 males, 54 females; mean age 29mo, range 1-69mo) were included. Functional abilities of children with CP equalled levels I to III in the Gross Motor Function Classification System. Medial gastrocnemius muscle volume was constructed from serial, transverse, two-dimensional ultrasonography images. In typically developing children, medial gastrocnemius volume increased linearly with age. Among children with CP, medial gastrocnemius volume increased less with age and deviated significantly from typically developing children at 15 months of age (p<0.05). Bone length increased with age without significant difference (p=0.49). Muscle growth in children with CP initially follows that of typically developing children, but decreases at 15 months of age. This may be related to reduced physical activity and neural activation of the muscle. Interventions stimulating muscle growth in young children with CP may be important to prevent contractures.

Assessing speech perception in children with hearing loss: what conventional clinical tools may miss.

This study tested the hypothesis that word recognition in a complex, two-talker masker is more closely related to real-world speech perception for children with hearing loss than testing performed in quiet or steady-state noise. Sixteen school-age hearing aid users were tested on aided word recognition in noise or two-talker speech. Unaided estimates of speech perception in quiet were retrospectively obtained from the clinical record. Ten parents completed a questionnaire regarding their children's ease of communication and understanding in background noise. Unaided performance in quiet was correlated with aided performance in competing noise, but not in two-talker speech. Only results in the two-talker masker were correlated with parental reports of their children's functional hearing abilities. Speech perception testing in a complex background such as two-talker speech may provide a more accurate predictor of the communication challenges of children with hearing loss than testing in steady noise or quiet.

Brain structural connectivity increases concurrent with functional improvement: evidence from diffusion tensor MRI in children with cerebral palsy during therapy.

Cerebral Palsy (CP) refers to a heterogeneous group of permanent but non-progressive movement disorders caused by injury to the developing fetal or infant brain (Bax et al., 2005). Because of its serious long-term consequences, effective interventions that can help improve motor function, independence, and quality of life are critically needed. Our ongoing longitudinal clinical trial to treat children with CP is specifically designed to meet this challenge. To maximize the potential for functional improvement, all children in this trial received autologous cord blood transfusions (with order randomized with a placebo administration over 2 years) in conjunction with more standard physical and occupational therapies. As a part of this trial, magnetic resonance imaging (MRI) is used to improve our understanding of how these interventions affect brain development, and to develop biomarkers of treatment efficacy. In this report, diffusion tensor imaging (DTI) and subsequent brain connectome analyses were performed in a subset of children enrolled in the clinical trial (n = 17), who all exhibited positive but varying degrees of functional improvement over the first 2-year period of the study. Strong correlations between increases in white matter (WM) connectivity and functional improvement were demonstrated; however no significant relationships between either of these factors with the age of the child at time of enrollment were identified. Thus, our data indicate that increases in brain connectivity reflect improved functional abilities in children with CP. In future work, this potential biomarker can be used to help differentiate the underlying mechanisms of functional improvement, as well as to identify treatments that can best facilitate functional improvement upon un-blinding of the timing of autologous cord blood transfusions at the completion of this study.

Chapter 41 - Sequelae in children: developmental consequences

Child traumatic brain injury (TBI) is a major cause of disability in early life. Unlike in adults, a TBI in childhood causes an insult to a brain that is developing, potentially affecting future brain maturation, neural connectivity, and the acquisition of new skills. This review considers how such early brain insult may impact children's functional abilities, and how these processes may link with differential patterns of recovery across infancy, childhood, and adolescence. We also review evidence for cognitive impairment across a range of domains (IQ, attention, processing, memory executive function) and common educational, behavioral, and social consequences associated with child TBI. While impairments in all of these domains have been reported, in fact outcomes from child TBI are surprisingly varied and difficult to predict. To assist in understanding what may contribute to outcomes, we discuss predictive factors (injury severity, child and environment status) and research reporting on their individual and combined effect on recovery. The identification of such outcome predicators has led to an emerging literature in the area of intervention and rehabilitation that we also summarize. Finally, it concludes with discussion of the future direction of pediatric TBI research.

Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments.

This study aimed to document the prevalence and patterns of oral phase oropharyngeal dysphagia (OPD) in preschool children with cerebral palsy (CP), and its association with mealtime duration, frequency and efficiency. Cross-sectional population-based cohort study of 130 children diagnosed with CP at 18-36 months ca (mean = 27.4 months, 81 males) and 40 children with typical development (mean = 26.2, 18 males). Functional abilities of children with CP were representative of a population sample (GMFCS I = 57, II = 15, III = 23, IV = 12, V = 23). Oral phase impairment was rated from video using the Dyspahgia Disorders Survey, Schedule for Oral Motor Impairment, and Pre-Speech Assessment Scale. Parent-report was collected on a feeding questionnaire. Mealtime frequency, duration and efficiency were calculated from a three day weighed food record completed by parents. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS). Overall, 93.8% of children had directly assessed oral phase impairments during eating or drinking, or in controlling saliva (78.5% with modified cut-points). Directly assessed oral phase impairments were associated with declining gross motor function, with children from GMFCS I having a 2-fold increased likelihood of oral phase impairment compared to the children with TD (OR = 2.0, p = 0.18), and all children from GMFCS II-V having oral phase impairments. Difficulty biting (70%), cleaning behaviours (70%) and chewing (65%) were the most common impairments on solids, and difficulty sipping from a cup (60%) for fluids. OPD severity and GMFCS were not related to mealtime frequency, duration or efficiency, although children on partial tube feeds had significantly reduced mealtime efficiency. Oral phase impairments were common in preschool children with CP, with severity increasing stepwise with declining gross motor function. The prevalence and severity of oral phase impairments were significantly greater for most tasks when compared to children with typical development, even for those with mild CP. Children who were partially tube fed had significantly lower feeding efficiency, so this could be a useful early indicator of children needing supplementation to their nutrition (through increasing energy density of foods/fluids, or tube feeds).

Implementation and outcome of child psychotherapy compared with other psychiatric treatments in a naturalistic clinical setting

Background: Mental health problems of children are commonly treated by psychotherapy and other psychosocial treatments. Studies comparing different treatments in naturalistic clinical settings are few, however. Aims: We assessed the differences: 1) in symptoms and diagnoses; 2) in treatment outcome between psychotherapy and other psychosocial treatments; and 3) evaluated the effect of family background and life circumstances on the outcome. Methods: The data were collected from the psychiatric hospital records of Oulu University Hospital, Finland. All 118 children (aged < 16 years) referred to psychotherapy from the Department of Child Psychiatry in 1996–2005 and 118 age- and sex-matched children undergoing other psychosocial treatments were included. A lack of later recorded psychiatric problems was used as an indicator of good treatment outcome. Results: On referral, functional ability was severely impaired in almost half of the children (Children's Global Assessment Scale score < 55). Internalizing symptoms were more common in the psychotherapy group, while no difference was found in externalizing symptoms between the groups. In both groups, later psychiatric problems were associated with a child's low functional ability and poor parental coping with their responsibilities. Children with internalizing problems had impaired prognosis if they had psychosocial treatments other than psychotherapy. Conclusions: Individual psychotherapy should especially be considered for children with internalizing symptoms, but the outcome of psychiatric treatment depends not only on children's own functional abilities, but also on parental abilities.

Care coordination, family-centered care, and functional ability in children with special health care needs in the United States.

The purpose of this study was to determine if there was an association between care coordination, family-centered care, and functional ability among children with special health care needs (CSHCN). Analysis of data from the 2005-2006 National Survey of CSHCN revealed that the percentages of CSHCN receiving care coordination and family-centered care were 59.3 and 66.3, respectively. Children who did not receive care coordination had a 53% higher adjusted odds (odds ratio=1.53, 95% confidence interval 1.21-1.94, P<0.001) for a limitation in functional ability compared to CSHCN who received care coordination. Family-centered care was not associated with a limitation in functional ability in CSHCN (P=0.61). CSHCN are underserved with regard to care coordination and this appears to be associated with impaired functional ability. Longitudinal studies are needed to confirm causality.

Effect of resistance and aerobic exercises on bone mineral density, muscle strength and functional ability in children with hemophilia

Background and purposeChildren with hemophilia are at risk for reduced bone mineral density (BMD), muscle strength and functional ability as a result of reduced leisure-time activity and less involvement in intense activities. So, the purpose of this study was to investigate the effect of resistance and aerobic exercise program on BMD, muscle strength and functional ability in children with hemophilia. Materials and methodsThirty boys with hemophilia A ranging in age from 10 to 14years had participated in this study. They were assigned randomly into two equal groups (control and study groups). Control group received a designed physical therapy program and aerobic exercise in the form of treadmill training, while the study group received the same program as the control group in addition to resistance training program in the form of bicycle ergometer training and weight resistance. Both groups received treatment sessions three times per week for three successive months. BMD, muscle strength of knee flexors and extensors and functional ability were evaluated before and after the 3months of treatment program. ResultsThere was no significant difference between both groups in the pre-treatment mean values of all measured variables. Significant improvement was observed in BMD, knee extensors and flexors strength, and functional ability in the study group when comparing pre and post treatment measurements. There was a significant improvement in functional ability of the control group. Significant difference was also observed between both groups when comparing the post treatment measurements in favor of the study group. ConclusionBased on obtained data, it can be concluded that, resistance and aerobic exercise training program is effective in increasing BMD, muscle strength and functional ability in children with hemophilia.

Relationship between static postural control and the level of functional abilities in children with cerebral palsy.

Background: Postural control deficits can impair functional performance in children with cerebral palsy (CP) in daily living activities. Objective: To verify the relationship between standing static postural control and the functional ability level in children with CP. Method: The postural control of 10 children with CP (gross motor function levels I and II) was evaluated during static standing on a force platform for 30 seconds. The analyzed variables were the anteroposterior (AP) and mediolateral (ML) displacement of the center of pressure (CoP) and the area and velocity of the CoP oscillation. The functional abilities were evaluated using the mean Pediatric Evaluation of Disability Inventory (PEDI) scores, which evaluated self-care, mobility and social function in the domains of functional abilities and caregiver assistance. Results: Spearman's correlation test found a relationship between postural control and functional abilities. The results showed a strong negative correlation between the variables of ML displacement of CoP, the area and velocity of the CoP oscillation and the PEDI scores in the self-care and caregiver assistance domains. Additionally, a moderate negative correlation was found between the area of the CoP oscillation and the mobility scores in the caregiver assistance domain. We used a significance level of 5% (p <0.05). Conclusions:We observed that children with cerebral palsy with high CoP oscillation values had lower caregiver assistance scores for activities of daily living (ADL) and consequently higher levels of caregiver dependence. These results demonstrate the repercussions of impairments to the body structure and function in terms of the activity levels of children with CP such that postural control impairments in these children lead to higher requirements for caregiver assistance.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

Objective: To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions. Data sources: Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011. Review methods: Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools. Results: Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools’ reliability was more prevalent than evidence of the tools’ validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided. Conclusion: Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child’s and family’s perspective.

FRI0477-HPR The efficacy of land-based home exercise program in patients with juvenile idiopathic arthritis: A randomized-controlled, single-blind study

BackgroundJuvenile idiopathic arthritis (JIA) is a common chronic illness that affects 1 in 1,000 children (1). Patients with JIA may experience significant disability due to muscular weakness, joint pain, contracture,...