ORCID Profile
0000-0003-2627-9495
Current Organisations
University of South Florida
,
UNSW Sydney
,
Children's Hospital at Westmead
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Publisher: Wiley
Date: 03-03-2021
DOI: 10.1111/JPC.15429
Abstract: Oral medications are often first‐line medical management for children with cerebral palsy who have generalised dystonia however, evidence for their effectiveness is limited and dosing practices are inconsistent. As a first step to improve consistency, this study aimed to examine current clinical practice of expert doctors for prescribing medications for children with dystonic cerebral palsy including prescribing patterns and combinations of medications used. This was a prospective surveillance study of medical doctors working in major Australian centres who manage children with cerebral palsy. Each week over a continuous 6‐month period, doctors completed a custom developed online survey for children seen that week with dystonic cerebral palsy for whom they prescribed a new medication to treat dystonia. Twenty‐five doctors consented to participate, 16 of whom prescribed new medications for dystonia in children with cerebral palsy over the study period. There were 77 children who were prescribed new medications. Baclofen and gabapentin were prescribed most, followed by levodopa, trihexyphenidyl and diazepam. The most common combinations of medications were baclofen and diazepam or baclofen and gabapentin. Dosage regimens were variable, particularly for trihexyphenidyl and diazepam. Inconsistencies in dosing regimens remain for oral medication prescription by Australian doctors when managing dystonia in cerebral palsy. Future studies using the consensus of expert clinicians will be conducted to develop guidelines in an area where the evidence for in idual medications is extremely limited.
Publisher: BMJ
Date: 24-07-2020
DOI: 10.1136/ARCHDISCHILD-2020-319541
Abstract: To determine rates of psychiatric comorbidity in a clinical s le of childhood movement disorders (MDs). Cohort study. Tertiary children’s hospital MD clinics in Sydney, Australia and London, UK. Cases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438). On-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists. Diagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses. Psychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, p .0001) and the community cohort (9.5%, p .00001), but not the neurology controls (29.7%, p=0.31). Almost half of the patients within the tic cohort with psychiatric comorbidity were receiving medical psychiatric treatment (45.5%) or psychology interventions (43.9%), compared with only 22.5% and 15.0%, respectively, of the non-tic MD cohort with psychiatric comorbidity. Psychiatric comorbidity is common in non-tic MDs such as dystonia. These psychiatric comorbidities appear to be under-recognised and undertreated.
Publisher: Elsevier BV
Date: 11-2003
DOI: 10.1016/S0749-0712(03)00061-1
Abstract: Spasticity or dystonia of the upper limb in children with CP commonly is seen as part of a more involved clinical picture. Each can cause functional problems in and can interfere with the quality of life of children with CP. Pharmacologic manipulation of the spasticity and dystonia requires a patient and ordered approach. Treatment often is performed using an open trial method, with medications introduced slowly but often being limited in their usefulness by significant side effects. Despite multiple medications being available for spasticity and dystonia management, few of the oral treatments have been assessed systematically in children with CP. Specific evaluation of the use of enteral medications in upper limb management is even rarer.
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1016/J.APMR.2003.05.008
Abstract: To describe the functional and family-centered assessment protocol and outcomes of a phase II trial evaluating upper-limb function after botulinum toxin injections in children with cerebral palsy (CP). Intervention study, case series, phase II trial, follow-up at 2 weeks and 3 and 6 months. Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital. Convenience s le of 16 children with CP (age range, 2-12y). Botulinum toxin type A (Botox) injections after electrical stimulation localization of appropriate muscle. The Canadian Occupational Performance Measure (COPM), Goal Attainment Scale (GAS), Melbourne Assessment of Unilateral Upper Limb Function, Child Health Questionnaire (CHQ), parent questionnaire, Modified Ashworth Scale (MAS), Tardieu scale, and active (AROM) and passive (PROM) range of motion. On the COPM, there was significant improvement at 3 months and 6 months. On the GAS, the T-scores were 42 and 47 at 3 and 6 months, respectively. On the Melbourne Assessment and CHQ, there was no significant change. The parent questionnaire indicated acceptability of injections and positive outcomes. On the MAS, there was a significant reduction in tone at 2 weeks, with a return to baseline by 6 months. On the Tardieu scale, there was a significant increase in angle of first catch at 2 weeks, but only the elbow maintained a significant difference at 3 and 6 months. No significant change was found for AROM or PROM. Sustained functional outcomes occurred after botulinum toxin injections despite increasing muscle tone after an initial reduction in tone. Randomized controlled trials are required.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.APMR.2006.10.017
Abstract: To investigate the functional outcomes of botulinum toxin type A (BTX-A) injections to the upper limb in combination with occupational therapy (OT) in children with cerebral palsy (CP). Randomized controlled trial with follow-up at 2 weeks, 3 months, and 6 months. Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital. Eighty children with spastic quadriplegic, triplegic, or hemiplegic CP from these clinics were randomly assigned to BTX-A plus OT, BTX-A alone, OT alone, or a no-treatment control group. Single set of BTX-A (Botox) injections and 12 weeks of OT. Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS). The combination of BTX-A and OT resulted in accelerated attainment of functional goals measured by the COPM and GAS. There were no differences between groups on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, Child Health Questionnaire, or active and passive range of motion. As expected, there was a significant reduction in muscle tone at follow-up 2 weeks after injection, which returned to baseline level by 6 months. OT enhanced in idualized functional outcomes following BTX-A injections in the upper limbs of children with CP.
Publisher: SAGE Publications
Date: 30-01-2009
Abstract: The aim of this study was to assess trihexyphenidyl in reducing overall dystonia, improving upper limb function, and achieving goals in children with dystonic cerebral palsy. A randomized, double-blinded, placebo-controlled, crossover trial was conducted with 16 participants at a tertiary children's hospital. Assessments were performed at baseline, week 12, and week 28. The primary outcome measure was the Barry-Albright Dystonia scale for global assessment of dystonia. Secondary measures included the Quality of Upper Extremity Skills Test, Canadian Occupational Performance Measure, and Goal Attainment Scale. A total of 14 children (88%) completed the study. Mean baseline Barry-Albright Dystonia score was 18.4 (95% confidence interval, 15.5-21.2). There were no significant treatment effects as measured by change in outcome scores. There were significant order effects for both the Goal Attainment Scale and performance aspect of the Canadian Occupational Performance Measure. Side effects were common. Larger experimental trials with more narrowly defined functional levels are indicated.
Publisher: BMJ
Date: 23-03-2018
DOI: 10.1136/ARCHDISCHILD-2017-314051
Abstract: To investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital. A prospective cohort study of near-drowning children. 95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia. 23 children both met the criteria and had parental consent for the study. Identification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF. 95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up. Children admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.
Publisher: Wiley
Date: 25-09-2020
DOI: 10.1111/JPC.15194
Publisher: Wiley
Date: 22-12-2009
Publisher: Springer Science and Business Media LLC
Date: 14-12-2018
DOI: 10.1038/S41393-018-0209-5
Abstract: Literature review. Globally map key paediatric spinal cord damage epidemiological measures and provide a framework for an ongoing repository of data. Worldwide, initiative of ISCoS Prevention Committee. Literature search of Medline (1946-March 2017) and Embase (1974-March 2017). Relevant articles in any language regarding children with spinal cord damage included. Stratification of data quality into Green/Yellow /Red 'zones' facilitated comparison between countries. A total of 862 abstracts were reviewed and data from 25 articles were included from 14 countries in 6 of the 21 Global Regions. Fourteen studies involved paediatric traumatic spinal cord injury (SCI) and seven were regarding non-traumatic spinal cord dysfunction (SCDys). An additional four articles provided both paediatric SCI and SCDys data. The median SCI incidence rates in Global Regions were: Asia, East 5.4/million population/year Australasia 9.9/million population/year Western Europe 3.3/million population/year and North America, High Income 13.2 million population/year. The median SCDys incidence rates in Global Regions were: Australasia 6.5/million population/year Western Europe 6.2/million population/year and North America, High Income 2.1/million population/year. SCI was mostly due to land transport (46-74%), falls (12-35%) and sport/recreation (10-25%) and SCDys was mostly caused by tumours (30-63%) and inflammatory/autoimmune causes (28-35%). There is a scarcity of quality epidemiology studies of paediatric SCD regarding incidence, prevalence, aetiology and survival. Recent ISCoS frameworks provide guidance for researchers to use established classification of SCDys and age group cut-off levels in future studies, thereby improving the ability to compare and combine data.
Publisher: Elsevier BV
Date: 03-2012
Publisher: Informa UK Limited
Date: 12-2004
DOI: 10.1080/09297040490909279
Abstract: Magnetic Resonance Spectroscopy (MRS) and its association with neuropsychological functioning was examined in the chronic injury phase of paediatric traumatic brain injury (TBI). Fifteen children, aged 10-16 years, with severe TBIs were compared with 15 controls, matched for age and gender. The TBI group was found to have significantly lower levels of -acetyl aspartate (NAA) and Choline (Cho) in the right frontal lobe and generally displayed reduced performances on neuropsychological tests. A correlation between metabolites and reaction times was also obtained. Findings indicate a role of proton MRS as a measure of neuronal integrity following severe paediatric TBI and suggest a potential association of MRS with specific neuropsychological impairments.
Publisher: Elsevier BV
Date: 09-2015
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S12887-021-02847-1
Abstract: Gabapentin is often used to manage pain in children with dystonic cerebral palsy, however the evidence for its effectiveness in this population is limited. The primary objective of this feasibility pilot study was to assess the factors which might impact on a future randomised controlled trial including the ability to recruit and retain participants, assess adherence/compliance to the prescribed intervention, and ability to complete all outcome assessments. The secondary objective was to gather preliminary evidence for the effectiveness of gabapentin at reducing pain, improving comfort and reducing dystonia in children with dystonic cerebral palsy. This open label pilot study recruited children aged 5–18 years with dystonic cerebral palsy and accompanying pain affecting daily activities from four centres around Australia. Children were prescribed gabapentin for 12 weeks and were assessed at baseline, 6 weeks and 12 weeks. The primary outcome was feasibility of the protocol. Secondary outcomes were pain behaviour, pain intensity, care and comfort, in idualised goal setting and dystonia severity. Thirteen children (mean age 10.4 years (SD 2.4yrs), 9 females) were recruited from 71 screened over 15 months. Two children withdrew while eight children experienced side effects. There were issues with adherence to medication dosage regimens and data collection. Improvements were seen in pain behaviour, comfort and pain related goals at 12 weeks. Dystonia was not significantly changed. Whilst gabapentin has potential to improve pain and comfort in children with dystonic CP, the feasibility of implementing a definitive randomised controlled trial is low. Alternative trials designs are required to further examine the effectiveness of gabapentin in this heterogeneous population. The trial was registered with the Australian Clinical Trial Registry ( ACTRN12616000366459 ) on 22/03/2016 and the Therapeutic Goods Administration (CT-2016-CTN-00500-1) on 22/06/2016.
Publisher: Wiley
Date: 03-06-2011
DOI: 10.1111/J.1469-8749.2011.03992.X
Abstract: Studies on the use of intrathecal baclofen (ITB) for ambulant adults with spasticity and/or dystonia of cerebral origin are scarce, and are even more limited for children and adolescents. This systematic review investigates the use of ITB to improve walking, transfer ability, and gross motor activities in ambulant children and adolescents with spasticity and/or dystonia of cerebral origin. Electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, full Cochrane Library, and PEDro) were searched from the earliest date available until March 2011 using combined subject headings and free text if supported by the databases. Studies were included if they had examined in iduals who: (1) received ITB therapy by any method (bolus injection, an external delivery system, or an implanted pump) (2) had spasticity and/or dystonia of cerebral origin (3) were able to ambulate with or without a walking device, i.e. in iduals with cerebral palsy (CP) who were in levels I to III of the Gross Motor Function Classification System or in iduals with similar functional mobility if they did not have CP and (4) were aged 18 years or under. Publications in English in peer-reviewed journals reporting any type of research design, except reviews and expert opinions, were included. Studies were excluded if participants had spasticity and/or dystonia of spinal origin and if baclofen was administered only orally. Studies that compared ITB with other interventions such as botulinum toxin were also excluded. Two independent reviewers scored 16 studies against the guidelines for developing systematic reviews from the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). Fifteen studies were of levels IV or V evidence and only one of level II according to the evidence levels of the AACPDM guidelines, but all were of low quality. No study was found on the use of ITB in ambulant children or adolescents with dystonia of cerebral origin. Not all studies used objective outcome measures to assess the ambulation, transfer ability, and gross motor activities of the participants. A proportion of participants showed improvement in all these areas but adverse events were common. A proportion of participants compromised their ambulatory and transfer abilities after ITB. There was no evidence to support the clinical use of ITB in ambulant in iduals with hypertonicity without further rigorous longitudinal studies.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2019
Publisher: Wiley
Date: 18-01-2011
DOI: 10.1111/J.1469-8749.2010.03814.X
Abstract: The aim of this study was to assess changes in health status before and after, as well as adverse events after, botulinum toxin type A (BoNT-A) injections in children with cerebral palsy (CP). A total of 334 children (190 male 144 female) aged 1y 6mo to 19y 4mo (mean 9y 2mo, SD 4y) with CP who were undergoing BoNT-A injections (596 injection courses in total) were clinically audited over a 16-month period. Of the 334 children, 62 were classified at Gross Motor Function Classification System (GMFCS) level I, 52 of whom had unilateral CP and 10 of whom had bilateral CP. Eighty-six children were classified at GMFCS level II, 39 of whom had unilateral CP and 47 of whom had bilateral CP. Forty-four children were classified at GMFCS level III, two of whom had unilateral CP and 42 of whom had bilateral CP. Sixty-six of the 334 children were classified at GMFCS level IV and 76 as level V. All the children classified as level IV or V had bilateral involvement. The health status of the children in the month before and a prospective audit of health status and adverse events in the month after BoNT-A injections were examined in order to assess the effects of the toxin. The data gathered for the month before administration of BoNT-A indicated that children with CP had significant background morbidities. After injection of BoNT-A, adverse events occurred in 23.2% of children. All adverse events were temporary and there were no deaths. The results of this audit indicate that there is insufficient evidence to warrant restriction of the administration of BoNT-A in children with CP at any GMFCS level in our service.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/BPO.0000000000000919
Abstract: Outcomes after orthopaedic interventions in patients with dystonic cerebral palsy (DCP) are historically regarded as unpredictable. This study aims to evaluate the overall outcome of orthopaedic surgery in children with DCP. Children with DCP who underwent lower limb orthopaedic surgery with a minimum follow-up of 12 months were included. Data collected included age at time of surgery, surgical procedures performed, Gross Motor Function Classification System (GMFCS) level, and Barry Albright Dystonia Scale (BADS) score. The cohort was ided into 2 groups. Group 1 (GMFCS levels I to III), mean age 12 years 7 months and group 2 (GMFCS levels IV to V), mean age 10 years 7 months. Group 1 had surgery aimed at deformity correction to improve gait and mobility, and group 2 for the management or prevention of hip displacement. Outcome measures analyzed were: the incidence of unpredictable results related to surgery and early recurrence of deformity in both groups. Functional mobility scale scores were evaluated for group 1 and hip migration percentage for group 2. Linear mixed models were used to take into account repeated measures over time and correlations between measurements from the same patient. Group 1 (n=18) had low BADS scores and were considered to have mild dystonia. Three children experienced unpredictable results, 2 had early recurrence of deformity, 3 had a decline, and 1 child improved in the functional mobility scale. Group 2 (n=19) had high BADS scores and were considered to have moderate to severe dystonia. Nine surgical events involved bony procedures and 15 were soft tissue surgery only. One surgical event lead to unpredictable results and 2 children had early recurrence of deformity. Postoperatively, a linear trend of increasing migration percentage [0.49% (95% confidence interval, 0.23-0.74 P =0.0002)] was seen up to 21 months. There was no significant change after 21 months [−0.08% (95% confidence interval, −0.24 to +0.041 P =0.18)]. This study suggests that unpredictable results and early recurrence of deformity following orthopaedic surgery in children with DCP are not as common as previously regarded. Furthermore, functional mobility and hip morphology can be improved. Level IV—this is a case-series.
Publisher: Wiley
Date: 29-04-2019
DOI: 10.1002/MDS.27708
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
Publisher: Wiley
Date: 22-12-2009
DOI: 10.1111/J.1365-2214.2009.01005.X
Abstract: Rehabilitation professionals strive to provide high-quality evidence-based services for children. Developing systems to measure and monitor the benefits of our services, and health outcomes for children is complex and challenging. The Community Outcome Project aims to introduce systematic outcome measurement across the network of paediatric community-based brain injury services within the New South Wales Brain Injury Rehabilitation Program (BIRP) to support clinical practice and service evaluation. A literature review informed the development of the evaluative framework and identified available paediatric outcome measures which may be appropriate. Extensive consultation with clinicians supported project planning and identified clinical priorities that the outcome measures needed to capture. Outcome measures were shortlisted by matching them to identified clinical priorities, and then trialled in clinical practice. Qualitative feedback regarding clinical utility and feasibility was obtained from clinical staff. The process has utilized change management strategies to ensure the success of the project and keep staff engaged. The process identified the three main clinical priorities for outcome measurement - family functioning, school performance and participation. Three outcome measures were chosen for the pilot project that is currently underway. They are Family Burden of Injury Interview, Academic Competence and Evaluation Scales and Child and Adolescent Scale of Participation. Plans for analyses of outcome data within the paediatric BIRP services are discussed. Extensive preparation is required to optimize staff engagement in a project that systematically introduces outcome measures that are useful to clinicians, clients and service providers. Managing the change required is a key focus of the project. Benefits and costs to clinicians and services will be discussed.
Publisher: Wiley
Date: 04-03-2022
DOI: 10.1111/DMCN.15197
Abstract: To determine factors that influence non‐attendance at outpatient clinics by children with cerebral palsy (CP). This was a retrospective cohort study of 1395 children with CP (59.6% male born 2005 to 2017) identified from the New South Wales (NSW)/Australian Capital Territory CP Register, who had scheduled appointments at outpatient clinics at two NSW tertiary paediatric hospitals between 2012 and 2019. Associations between sociodemographic, clinical, and process‐of‐care factors and non‐attendance were examined using multivariate logistic regression with generalized estimating equations. A total of 5773 (12%) of 50 121 scheduled outpatient days were not attended. Non‐attendance increased over time (average increase 5.6% per year, 95% confidence interval [CI]: 3.7–7.3). Older children aged 5 to 9 years (adjusted odds ratio [aOR] 1.11 95% CI: 1.02–1.22) and 10 to 14 years (aOR 1.17 95% CI: 1.03–1.34), socioeconomic disadvantage (aOR 1.29 95% CI: 1.11–1.50), previous non‐attendance (aOR 1.38 95% CI: 1.23–1.53), and recent rescheduled or cancelled appointments (aOR 1.08 95% CI: 1.01–1.16) were associated with increased likelihood of non‐attendance. One in eight outpatient appointments for children with CP were not attended. Non‐attendance was associated with increasing age, socioeconomic disadvantage, previous non‐attendance, and recent rescheduled or cancelled appointments. Identifying specific barriers and interventions to improve access to outpatient services for these groups is needed. Twelve per cent of scheduled appointments for children with cerebral palsy are not attended. Proportions of appointments not attended has increased over the last decade. Increasing age and socioeconomic disadvantage increase the likelihood of non‐attendance. Previous non‐attendance and recent cancelled or rescheduled appointments increase the likelihood of further non‐attendance.
Publisher: Wiley
Date: 05-2004
DOI: 10.1111/J.1440-1754.2004.00374.X
Abstract: Abstract: Severe dystonia or status dystonicus is a life threatening disorder that develops in patients with both primary and secondary dystonia. We present the case of a 9‐year‐old boy with Hallervorden‐Spatz disease (HVS) who developed status dystonicus, failing to respond to high dose oral therapy with multiple antidystonic agents. High dose intravenous sedating agents combined with endotracheal intubation and mechanical ventilation were required to control the spasms. Alleviation of the spasms was achieved by a combination of temporary intrathecal baclofen infusions and bilateral pallidotomy. Although it could be argued this is a situation where only palliative measures should be used, we believe a relatively aggressive approach was justified. It relieved the intense pain associated with the spasms and allowed the child to be discharged home without the prolonged stay in intensive care, morbidity and mortality, which characterize status dystonicus.
Publisher: Informa UK Limited
Date: 14-05-2012
DOI: 10.3109/17518423.2012.671381
Abstract: To examine the inter-rater reliability of The King's Outcome Scale for Childhood Head Injury (KOSCHI) with clinicians of varying experience in paediatric traumatic brain injury (TBI) and to examine change in outcome during long-term follow-up of children following traumatic brain injury (TBI) using KOSCHI. Retrospective assessment of detailed clinic reports of 97 children followed-up by a tertiary specialist paediatric brain injury service. Investigators were blinded to each other's scores. Inter-rater reliability was substantial (weighted kappa 0.71) and similar for investigators of varying experience. KOSCHI outcome was strongly associated with markers of injury severity (p = 0.028). In longitudinal follow-up, KOSCHI score worsened in 7 (23%) children who were injured under 8 years but in no older children (p = 0.02). KOSCHI has high inter-rater reliability for investigators of different experience. Long-term KOSCHI outcome is associated with injury severity. Some young children may develop worse disability over time.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/17518420701409764
Abstract: To document the serial changes in bone mineral density (BMD) following paediatric spinal cord injury (SCI). Retrospective case series. Paediatric tertiary care hospital. Eighteen children (nine males) followed in an outpatient spinal cord injury service. Not applicable. Serial bone mineral density (BMD) measurements using dual energy X-ray absorptiometry (DXA). Mean follow-up was 5.0 +/- 3.6 years (range 0.4-12.4 years). Three children sustained minimal trauma fractures, all femoral. For the cohort, BMD Z-scores were significantly less than zero in the legs (-2.7 +/- 2.0, p < 0.001), femoral neck (-2.1 +/- 1.4, p < 0.001), total body (-0.8 +/- 1.3, p=0.02) and lumbar spine (-0.8 +/- 1.6, p=0.04), but not in the arms (-0.2 +/- 1.0, p=0.5). Lean tissue mass (LTM) Z-scores were reduced in the legs (-1.9 +/- 1.3, p < 0.001). Longitudinal data showed an initial decline in lower extremity BMD, BMC and LTM aged-matched Z-scores in the 12 months following SCI, followed by an age appropriate increase thereafter. Lower extremity osteopenia and sarcopenia develop rapidly in the first 12 months following the SCI. The reduced bone strength increases the risk of low trauma fracture.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/17518420802259498
Abstract: The Paediatric Care and Needs Scale (PCANS) is a newly developed scale that assesses support needs following childhood acquired brain injury (ABI). It yields three measures of support: overall, extent and intensity. The developmental process of the PCANS is described and concurrent and construct validity examined. In the validation study, 32 parents/caregivers of children with ABI aged 5-18 years completed the PCANS and other validating measures: Vineland Adaptive Behavior Scales (VABS), Functional Independence Measure for Children (Wee-FIM) and King's Outcome Scale of Childhood Head Injury (KOSCHI). VABS and Wee-FIM sub-scales examining similar and dissimilar domains to the PCANS were used to investigate convergent and ergent validity, respectively. Discriminant validity analysis used sub-groups dichotomized by VABS and KOSCHI data. Statistically significant correlation coefficients of moderate-to-strong magnitude were found between the PCANS support intensity score and most of the VABS, Wee-FIM and KOSCHI variables (r(s) = -0.46 to r(s) = -0.77, p < 0.01). Some evidence for convergent and ergent validity was also found. Correlation coefficients between similar domains of the PCANS and other scales were moderately high (e.g. VABS socialization vs PCANS psychosocial items, r(s) = -0.64, p < 0.01). Conversely, correlation coefficients between dissimilar domains were low (e.g. Wee-FIM self-care vs PCANS psychosocial items, r(s) = -0.29). In terms of discriminant group differences, PCANS support extent and intensity scores were able to distinguish between sub-groups dichotomized by VABS and KOSCHI scores. These findings provide preliminary evidence for the validity of the PCANS for assessing support needs after paediatric ABI.
Publisher: Informa UK Limited
Date: 22-01-2021
Publisher: Wiley
Date: 06-10-2008
DOI: 10.1111/J.1468-1331.2008.02271.X
Abstract: To examine whether three-dimensional (3-D) kinematic analysis can detect changes in upper limb tasks (reach and hand-to-mouth) in children with hemiplegia, following upper limb botulinum toxin A injections. Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9-17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3-D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post-injection. Post-injections, elbow flexor muscle tone was reduced for 12 weeks (p 15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand-to-mouth tasks, respectively. 3-D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial.
Publisher: Wiley
Date: 12-1998
DOI: 10.1111/J.1469-8749.1998.TB12358.X
Abstract: The study investigates the neurological substrate in children with congenital disorders of the peripheral visual system (CDPVS), i.e. disorders of the anterior visual pathways and the globe. The design is retrospective brain MRI and/or CT scans were traced and reviewed for 79 of 254 children with CDPVS on our database. The neuroradiological findings were considered in the context of degree of visual impairment (profound [PVI] and severe [SVI]), developmental outcome (setback and non-setback), and mode of imaging (MRI and CT). Scans were abnormal in 40 of 79 (51%) children 23 of 40 (58%) had more than one lesion and in some children lesions not previously reported were found. The number of abnormalities per child was significantly higher in the PVI than the SVI group (P<0.05) the level of significance varied according to the method of scanning (MRI, P<0.001 CT, ns). Seven children were known to have had developmental setback significantly more brain abnormalities per child were found in the group with setbacks than in the group without (P<0.001). Eighty-six percent (24 of 28) of MRI compared with 38% (22 of 58) of CT scans were abnormal. MRI detected more lesions per child than CT (P< 0.001). Thus, a significant amount of brain pathology occurs in children with CDPVS. The number of lesions varies directly with degree of visual impairment and both correlate with developmental outcome. As brain pathology will be only one of many factors influencing developmental progress in visually impaired children, prospective multifactorial studies of the CDPVS population, which include MRI studies of the neurological substrate, will be required to clarify the latter.
Publisher: Wiley
Date: 07-2008
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.PRRV.2019.12.002
Abstract: Cerebral palsy (CP) is associated with a high burden of comorbid respiratory disease subsequent to multiple risk factors associated with increasing levels of disability. Correspondingly, respiratory disease is the leading cause of death in CP, including amongst young people who are transitioning or who have just transitioned between paediatric and adult healthcare services. Therefore, consideration of both preventive and therapeutic respiratory management is integral to transition in patients with CP, as summarised in this review.
No related grants have been discovered for Mary-Clare Waugh.