Functional Disability In Children Research Articles

A study of clinical profile and spectrum of functional disability in children with cerebral palsy

A study of clinical profile and spectrum of functional disability in children with cerebral palsy

Autonomy and competence satisfaction as resources for facing chronic pain disability in adolescence: a self-determination perspective

ABSTRACT This study aimed to test empirically the developmental goal pursuit model of paediatric chronic pain, which draws upon Self-Determination Theory for understanding risks and resources for living with chronic pain. This study examined the relationship between basic psychological need satisfaction (i.e. the satisfaction of the needs for autonomy, relatedness and competence) and the fear-avoidance model of pain in adolescents suffering from chronic pain. Hundred and twenty adolescents (mean age = 14.52, 71.6% female), receiving treatment through paediatric pain centres for chronic pain, were enrolled. Adolescents completed measures of basic psychological need satisfaction, fear and avoidance of pain, and pain-related functional impairment. Path analyses model indicated that higher levels of autonomy and competence satisfaction were associated with lower levels of functional disability, through the mediation of fear and avoidance of pain. Relatedness satisfaction was not significatively related to fear of pain, avoidance, and functional disability. The integration of Self-Determination Theory in the paediatric pain literature may further our understanding of potential resources for decreasing functional disability in children living with chronic pain.

Clinimetrics: Assessing functional disability in children and adolescents.

Clinimetrics: Assessing functional disability in children and adolescents.

Serebral Palsili Çocuğa Sahip Annelerin Anksıyete, Depresyon Ve Yaşam Kalitesi Düzeyleri

INTRODUCTION: The aim of this study was to investigate the relationship between the levels of anxiety, depression and quality of life in mothers of children with cerebral palsy and motor impairment in children with cerebral palsy. MATERIALS and METHODS: 98 mothers with children diagnosed with cerebral palsy were included in the study. Sociodemographic information of the participants was recorded. The Beck Anxiety Inventory(BAI), the Beck Depression Inventory (BDI) and the World Health Organization Short Form Turkish version (WHOQOL-BREF-TR) scale were applied to the mothers. The Pediatric Functional Independence Measurement (WeeFIM), the Gross Motor Function Classification System (GMFCS) and the Bimanuel Fine Motor Function (BFMF) scores were recorded. RESULTS: Differences in GMFCS, BFMF and WeeFIM scores of children with cerebral palsy were not related to BAI and BDI scores of mothers (p>0,05). There was a significant correlation between WeeFIM score and WHOQOL-BREF-TR social relations subtitle (p 0,05). CONCLUSIONS: Functional disability in children with cerebral palsy negatively affects the quality of life of mothers. Depression and anxiety levels of mothers are affected independently of the functional levels of children with cerebral palsy. It was concluded that increasing the quality of life of mothers who have children with cerebral palsy with physical, psychological and economic support would be important for mothers and their children, their families, social and professional environments.

Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta‐analysis

The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain. To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies. Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI=1.05-1.47), weekly day tiredness (OR 1.69; 95% CI=1.14-2.51), weekly abdominal pain (OR 1.44; 95% CI=1.03-2.02) and waking during the night (OR 1.49; 95% CI=1.05-2.13). No studies in community settings reported on prognostic factors for functional disability. Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution. Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.

Measuring functional disability in children with developmental disorders in low-resource settings: validation of Developmental Disorders-Children Disability Assessment Schedule (DD-CDAS) in rural Pakistan.

Developmental disorders (DDs) in children are a priority condition and guidelines have been developed for their management within low-resource community settings. However, a key obstacle is lack of open access, reliable and valid tools that lay health workers can use to evaluate the impact of such programmes on child outcomes. We adapted and validated the World Health Organization's Disability Assessment Schedule for children (WHODAS-Child), a lay health worker-administered functioning-related tool, for children with DDs in Pakistan. Lay health workers administered a version of the WHODAS-Child to parents of children with DDs (N = 400) and without DDs (N = 400), aged 2-12 years, after it was adapted using qualitative study. Factor analysis, validity, reliability and sensitivity to change analyses were conducted to evaluate the psychometric properties of the adapted outcome measure. Among 800 children, 58% of children were male [mean (s.d.) age 6.68 (s.d. = 2.89)]. Confirmatory Factor Analysis showed a robust factor structure [χ2/df 2.86, RMSEA 0.068 (90% CI 0.064-0.073); Tucker-Lewis Index (TLI) 0.92; Comparative Fit Index (CFI) 0.93; Incremental Fit Index (IFI) 0.93]. The tool demonstrated high internal consistency (α 0.82-0.94), test-retest [Intra-class Correlation Coefficient (ICC) 0.71-0.98] and inter-data collector (ICC 0.97-0.99) reliabilities; good criterion (r -0.71), convergent (r -0.35 to 0.71) and discriminative [M (s.d.) 52.00 (s.d. = 21.97) v. 2.14 (s.d. = 4.00); 95% CI -52.05 to -47.67] validities; and adequate sensitivity to change over time (ES 0.19-0.23). The lay health worker administrated version of adapted WHODAS-Child is a reliable, valid and sensitive-to-change measure of functional disability in children aged 2-12 years with DDs in rural community settings of Pakistan.

Exploring Traits of Autism and Their Impact on Functional Disability in Children with Somatic Symptom Disorder.

Subclinical traits of autism were measured in children with somatic symptom disorder (SSD, n = 28) and compared with age-matched controls (n = 26) using the Autism Spectrum Quotient (AQ) children's version. The KINDLR quality of life questionnaire was used to assess functional disability. Although there was no significant group difference in total traits of autism, SSD group had significantly greater difficulty in attention switching domain. Logistic regression analysis confirmed attention switching and age were associated with increased likelihood of SSD. In SSD group, difficulty in attention switching significantly negatively correlated with total, family, and friends quality of life scores. In conclusion, assessment and treatment targeting difficulties in attention switching could be useful when dealing with children with SSD.

Effect of Risperidone on the Motor and Functional Disability in Children With Choreoathetoid Cerebral Palsy

BackgroundTherapeutic options for management of choreoathetoid cerebral palsy, which is a permanent disorder, are limited. Available medications either have significant side effects or are unsuitable for long-term use. Risperidone has shown promise in the management of chorea and has been found to be safe in children less than five years. MethodsChildren with choreoathetoid cerebral palsy were enrolled after parental consent and given risperidone for six-month period along with standard care. The choreoathetoid movements were assessed using Abnormal Involuntary Movement Scale, the upper-limb functions were assessed using Quality of upper extremity skill tests, and the quality of life using Cerebral palsy-Quality of life. Side effects were monitored clinically, by biochemical tests and electrocardiogram. ResultsOf 42 children with choreoathetoid cerebral palsy who were screened over a period of one year, 35 subjects meeting the study criteria were enrolled. Thirty children completed six months of risperidone therapy, the remaining five subjects were excluded because of time missed due to intercurrent unrelated illnesses. Data of these 30 children were analyzed as per per-protocol analysis. Their mean age was 6.35 ± 3.17 years. Abnormal movements showed statistically significant decline after risperidone (19.7 vs 14.7, P < 0.0001). Functional ability of upper limbs and quality of life also showed improvement (37.0 vs 43.8, P < 0.0001 and 64.3 vs 70.0, P < 0.0001, respectively) after six months of risperidone therapy. Positive change in the behavior was also noted. It was well tolerated without significant side effects. ConclusionRisperidone is a promising drug to manage children with choreoathetoid cerebral palsy and is well tolerated in children.

Development of the Parent Responses to School Functioning Questionnaire

The 16-item PRSF measures parental responses to their child's chronic pain in the school context. The clinically useful measure can inform interventions aimed reducing functional disability in children with chronic pain by enhancing parents' ability to respond adaptively to child pain behaviors.

Rasch Analysis of the Arabic Language Version of the Functional Disability Inventory.

It is important for the responsive and effective treatment of pediatric cancer patients that functional disability is successfully measured, but no measures of functional disability have been validated for use with Arabic-speaking children and adolescents. The purpose of this study was to examine the psychometric characteristics of the first Arabic translation of the Functional Disability Inventory (FDI). A methodological study limited to the secondary analysis of functional disability data on 62 pediatric patients in Lebanon using the rating scale model and WINSTEPS Rasch analysis software was used. Disordered responses to 4 FDI times suggest that the Arabic translation of the rating scale categories might need revision or supplementation with a visual analogue scale. The dimensionality of the FDI needs further exploration because principal component analyses of residuals suggested the presence of secondary and possibly higher order dimensions. Additional FDI items are needed to improve targeting if low levels of functional disability are demonstrated to be clinically important for patient assessment and pain management. The FDI-A is suitable for clinical assessment and for monitoring the outcomes of pain management in Lebanese pediatric cancer patients. Our findings support the construct validity of the FDI-A and acceptable reliability for the 15-item scale, Cronbach α .93 and .85 for 4 of the item subsets we examined. Rating scale categories and the dimensionality of the FDI-A require further examination. The clinical relevance of distinctions between levels of functional disability in children and adolescents with cancer pain remains to be established.

Internalizing Symptoms and Functional Disability in Children With Noncardiac Chest Pain and Innocent Heart Murmurs

To examine the occurrence of internalizing symptoms and functional disability in children with noncardiac chest pain (NCCP) compared with children with innocent heart murmurs (IHMs). 67 children with NCCP (M [SD] age = 12.61 [2.63]; 68.7% Caucasian) and 62 children with IHM (M [SD] age = 12.67 [2.62]; 50% Caucasian) were recruited from pediatric cardiology offices. Children and parents completed measures of psychological functioning and functional disability during a first visit to the cardiologist before diagnosis. Children with NCCP reported greater levels of anxiety, depression, and anxiety sensitivity than children with IHM. Children with NCCP and their parents reported greater levels of functional disability and somatization than children with IHM and their parents. Children with NCCP experience greater levels of psychosocial distress and impairment than similarly physically healthy children with IHM. Consideration of psychosocial influences on NCCP would likely be beneficial in aiding assessment and treatment.

Sleep problems and functional disability in children with functional gastrointestinal disorders: An examination of the potential mediating effects of physical and emotional symptoms

BackgroundSleep disturbances are increasingly recognized as a common problem for children and adolescents with chronic pain conditions, but little is known about the prevalence, type, and impact of sleep problems in pediatric functional gastrointestinal disorders (FGIDs). The objectives of the current study were two-fold: 1) to describe the pattern of sleep disturbances reported in a large sample of children and adolescents with FGIDs; and, 2) to explore the impact of sleep by examining the inter-relationships between sleep disturbance, physical symptoms, emotional problems, and functional disability in this population.MethodsOver a 3-year period, 283 children aged 8–17 years who were diagnosed with an FGID and a primary caretaker independently completed questionnaires regarding sleep, emotional functioning, physical symptoms, and functional disability during an initial evaluation for chronic abdominal pain at a pediatric tertiary care center. A verbal review of systems also was collected at that time. Descriptive statistics were used to characterize the pattern of sleep disturbances reported, while structural equation modeling (SEM) was employed to test theorized meditational relationships between sleep and functional disability through physical and emotional symptoms.ResultsClinically significant elevations in sleep problems were found in 45% of the sample, with difficulties related to sleep onset and maintenance being most common. No difference was seen by specific FGID or by sex, although adolescents were more likely to have sleep onset issues than younger children. Sleep problems were positively associated with functional disability and physical symptoms fully mediated this relationship. Emotional symptoms, while associated with sleep problems, evidenced no direct link to functional disability.ConclusionsSleep problems are common in pediatric FGIDs and are associated with functional disability through their impact on physical symptoms. Treatments targeting sleep are likely to be beneficial in improving physical symptoms and, ultimately, daily function in pediatric FGIDs.

Brain‐behavior relationships in young traumatic brain injury patients: DTI metrics are highly correlated with postural control

Traumatic brain injury (TBI) is a major cause of impairment and functional disability in children and adolescents, including deterioration in fine as well as gross motor skills. The aim of this study was to assess deficits in sensory organization and postural ability in a young group of TBI patients versus controls by using quantitative force-platform recordings, and to test whether balance deficits are related to variation in structural properties of the motor and sensory white matter pathways. Twelve patients with TBI and 14 controls (aged 8-20 years) performed the Sensory Organisation Test (SOT) protocol of the EquiTest (Neurocom). All participants were scanned using Diffusion Tensor Imaging (DTI) along with standard anatomical scans. Quantitative comparisons of DTI parameters (fractional anisotropy, axial and radial diffusivity) between TBI patients and controls were performed. Correlations between DTI parameters and SOT balance scores were determined. Findings revealed that the TBI group scored generally lower than the control group on the SOT, indicative of deficits in postural control. In the TBI group, reductions in fractional anisotropy were noted in the cerebellum, posterior thalamic radiation, and corticospinal tract. Degree of white matter deterioration was highly correlated with balance deficits. This study supports the view that DTI is a valuable tool for assessing the integrity of white matter structures and for selectively predicting functional motor deficits in TBI patients.

Neurodevelopmental Disability Through 11 Years of Age in Children Born Before 26 Weeks of Gestation

To assess functional disability in children born before 26 weeks of gestation at 11 years of age and the stability of findings in individuals between 6 and 11 years of age. Of 307 surviving children born in 1995, 219 (71%) were assessed at 11 years of age alongside 153 classmates. Children were evaluated by using standardized tests of cognitive ability and clinical condition at both ages. Using classmate data to determine reference ranges, serious cognitive impairment (score of less than -2 SD) was present in 40% of extremely preterm children and 1.3% of classmates (odds ratio [OR]: 50 [95% confidence interval (CI): 12-206]) at 11 years of age. Overall, 38 (17%) extremely preterm children had cerebral palsy; moderate or severe impairment of neuromotor function, vision, and hearing was present in 10%, 9%, and 2% of these children, respectively. Combining impairment across domains, 98 (45%) extremely preterm children had serious functional disability compared with 1% of the classmates (OR: 61 [95% CI: 15-253]); this was more common in boys than girls (OR: 1.8 [95% CI: 1.0-3.1]) and in those born at 23 or 24 weeks' gestation compared with those born at 25 weeks' gestation (OR: 1.8 [95% CI: 1.0-3.1]). The prevalence of serious functional disability was 46% at 6 years of age and 45% at 11 years of age. Using multiple imputation to correct for selective dropout, it is estimated that 50% (95% CI: 44%-57%) of extremely preterm children are free of serious disability at 11 years of age. Extremely preterm children remain at high risk for neurodevelopmental disability at 11 years of age compared with term peers. The prevalence of disability remained stable between 6 and 11 years of age, and large individual shifts in classification of disability were unusual.

Testing Gender as a Moderator of Associations Between Psychosocial Variables and Functional Disability in Children and Adolescents with Chronic Pain

To evaluate gender as a moderator of associations between psychosocial variables and functional disability in children and adolescents with chronic pain. Participants included 266 patients (177 girls; mean age = 13.3 years) with chronic or recurrent headache or abdominal pain who were evaluated at a pediatric chronic pain clinic. Patients completed measures of pain intensity, anxiety, depression, pain coping, and functional disability. Parents completed a measure of protective behavior. Girls and boys reported similar levels of pain intensity. Girls were more likely to endorse depressive symptoms, and internalizing symptoms were associated with disability in girls, not in boys. No gender differences were found in links between coping and protective parenting and disability. In general, psychosocial factors influenced functional disability similarly in girls and boys, although some gender differences were found. Findings highlight the importance of considering child gender when evaluating factors that contribute to functional disability.

Joint functional disability in children of early age with olygoarticular juvenile arthritis

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Psychosocial Risks for Disability in Children With Chronic Back Pain

Psychosocial factors related to disability in adults with chronic back pain have been well studied, but little is known about factors associated with functional impairment in pediatric patients with chronic back pain. The purpose of this study was to examine whether 2 potential risk factors—use of catastrophizing as a coping technique and presence of a familial pain history—were associated with disability in pediatric back pain patients. Participants were 65 patients (ages 8-18) with chronic back pain seen at a multidisciplinary pain clinic. Patients completed measures of pain (visual analog scales), disability (Functional Disability Inventory), and catastrophizing (Internalizing/Catastrophizing subscale of the Pain Coping Questionnaire). Parents provided demographic information and familial pain history. Patients reported that chronic back pain caused disruptions in their daily functioning and they missed, on average, 2.5 days of school every month. Catastrophizing and familial chronic pain history both were significantly associated with greater disability, with use of catastrophizing being the stronger predictor of disability. This study presents important findings on potential psychosocial risk factors of functional disability in children and adolescents with chronic back pain. Future research might clarify mechanisms by which such coping styles are developed and explore how familial communication about pain might influence a child’s coping ability. Perspective Pediatric patients seeking treatment for chronic back pain often present with substantial functional impairment that is not well explained by disease variables or pain intensity. Two important psychosocial variables (catastrophizing and familial pain history) may provide a context for a better understanding of pain-related disability in children.

Functional disability in children with hemophilic arthropathy

Hemophilia is a coagulation disorder characterized by acute hemorrhages into the musculoskeletal system, leading eventually to arthropathy and disability. We investigated the functional loss, namely disability, in hemophiliacs. The clinical and radiological characteristics of joint involvement were also evaluated. There were 31 patients between the ages of 3 and 18 years and 65 involved joints. The knees were the most commonly affected joints followed by the elbows and ankles. There was a positive correlation between the radiological and clinical evaluation scores; however, the clinical evaluation score did not correlate with age. The radiological score increased in conjunction with increasing age of the patients. We observed a significant relationship between the disability score and the clinical evaluation and radiological scores. These observations suggest that hemophilia is a life-long condition, with a high potential for functional disability if not promptly and adequately controlled. The main principle in the treatment of hemophilic arthropathy is the restoration of the patient's lifestyle and mobility with a comprehensive multidisciplinary approach.

Age‐Dependent Relationships Among Pain, Depressive Symptoms, and Functional Disability in Youth With Recurrent Headaches

To assess age differences associated with depressive symptoms and functional disability in children and adolescents with recurrent headache. Research has indicated that psychological factors, especially depression, are related to the extent and nature of functional disability experienced from headaches. There is a lack of research examining how age impacts the relationship between pain, psychological factors, and activity restriction in children and adolescents with recurrent headache. Seventy-seven participants from a pediatric neurology clinic completed self-report measures of pain intensity, depressive symptoms, and functional disability. Findings demonstrated a significant positive correlation between pain and functional disability, and depressive symptoms and functional disability for children. Correlations for adolescents failed to reach significance. Functional disability emerged as a mediator between headache pain and depressive symptoms for children but not for adolescents. Results indicate potentially important age differences when examining the impact of functional disability on depressive symptoms in this sample. Findings suggest that functional disability may contribute to depressive symptoms differently for children versus adolescents with recurrent headache. Age-specific interventions that differentially focus on the specific roles that pain, depressive symptoms, and disability have for children and adolescents with recurrent headache may be warranted.

Relationships Between Family and Parent Characteristics and Functional Abilities in Children with Recurrent Pain Syndromes: An Investigation of Moderating Effects on the Pathway from Pain to Disability

To identify family characteristics associated with children's ability to function with recurrent pain. Seventy-eight children ages 7-17 years with recurrent pain syndromes [migraine headache or recurrent abdominal pain (RAP)] were recruited from clinic settings. Children completed pain diaries and the Functional Disability Inventory (FDI). Mothers and fathers completed self-report measures of psychological distress, and mothers reported on family environment. Controlling for the influence of pain intensity, family environment and parental distress jointly predicted children's ability to function with pain. Among children with migraine, family environment moderated the relationship between pain and functional disability; in this group, greater pain associated with more functional disability in children from disruptive family environments, but not in children from more adaptive family environments. For some pediatric recurrent pain sufferers, family characteristics associate with the extent of pain-related disability and may help identify children likely to experience more impaired functioning in response to recurrent pain.