ORCID Profile
0000-0002-4907-7477
Current Organisations
Curtin University
,
The University of Auckland
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Publisher: Informa UK Limited
Date: 03-07-2014
DOI: 10.3109/09638288.2014.935492
Abstract: To investigate the muscle size-strength relationship of the knee flexors and extensors in children with spastic cerebral palsy (CP) in relation to typically developing children (TD). Eighteen children with spastic Diplegia, Gross Motor Function Classification System I-III (mean 7 y 5 mo SD 1 y 7 mo) and 19 TD children (mean 7 y 6 mo SD 1 y 9 mo) participated. Muscle volume (MV) and anatomical cross-sectional area (aCSA) were assessed using MRI. Measures of peak torque (PT) and work of the knee flexors and extensors were assessed isometrically and isokinetically using a Biodex dynamometer, and normalised to bodymass (Bm). Children with CP were weaker than their TD peers across all torque variables (p < 0.05). MV and aCSA of the knee flexors (MV: p = 0.002 aCSA: p = 0.000) and extensors (MV: p = 0.003 aCSA: p < 0.0001) were smaller in children with CP. The relationship between muscle size and strength in children with CP was weaker than the TD children. The strongest relationship was between MV and isometric PT/Bm for TD children (r = 0.77-0.84), and between MV and isokinetic work (r = 0.70-0.72) for children with CP. Children with CP have smaller, weaker muscles than their TD peers. However, muscle size may only partially explain their decreased torque capacity. MV appears to be a better predictor of muscle work in children with CP than aCSA. This is an important area of research particularly in regard to treatment(s) that target muscle and strength in children with CP. Implications for Rehabilitation This research adds to the evidence that children with CP have smaller, weaker knee flexor and extensor muscles than their TD peers. However, unlike their TD peers, muscle size does not necessarily relate to muscle strength. The weak correlation between MRI-derived muscle volume and isometric peak torque suggests children with CP are underpowered relative to their muscle size. For children with CP, muscle volume appears to be the best predictor of isokinetic muscle torque output. Therefore, when assessing the capacity of a muscle, it appears preferable to measure total muscle volume and torque development through a range of motion (isokinetic strength).
Publisher: SAGE Publications
Date: 24-11-2017
Abstract: Despite the high prevalence of lower extremity injuries in female basketball players as well as a high proportion of athletes who wear ankle braces, there is a paucity of research pertaining to the effects of ankle bracing on ankle and knee biomechanics during basketball-specific tasks. To compare the effects of a lace-up brace (ASO), a hinged brace (Active T2), and no ankle bracing (control) on ankle and knee joint kinematics and joint reaction forces in female basketball athletes during a cutting maneuver. Controlled laboratory study. Twenty healthy, semi-elite female basketball players performed a cutting task under both ankle brace conditions (lace-up ankle brace and hinged ankle brace) and a no-brace condition. The 3-dimensional kinematics of the ankle and knee during the cutting maneuver were measured with an 18-camera motion analysis system (250 Hz), and ground-reaction force data were collected by use of a multichannel force plate (2000 Hz) to quantify ankle and knee joint reaction forces. Conditions were randomized using a block randomization method. Compared with the control condition, the hinged ankle brace significantly restricted peak ankle inversion (mean difference, 1.7° P = .023). No significant difference was found between the lace-up brace and the control condition ( P = .865). Compared with the lace-up brace, the hinged brace significantly reduced ankle and knee joint compressive forces at the time of peak ankle dorsiflexion (mean difference, 1.5 N/kg [ P = .018] and 1.4 N/kg [ P = .013], respectively). Additionally, the hinged ankle brace significantly reduced knee anterior shear forces compared with the lace-up brace both during the deceleration phase and at peak ankle dorsiflexion (mean difference, 0.8 N/kg [ P = .018] and 0.9 N/kg [ P = .011], respectively). The hinged ankle brace significantly reduced ankle inversion compared with the no-brace condition and reduced ankle and knee joint forces compared with the lace-up brace in a female basketball population during a cutting task. Compared with the lace-up brace, the hinged brace may be a better choice of prophylactic ankle support for female basketball players from a biomechanical perspective. However, both braces increased knee internal rotation and knee abduction angles, which may be problematic for a population that already has a high prevalence of knee injuries.
Publisher: Wiley
Date: 08-11-2021
DOI: 10.1111/JOA.13584
Abstract: The aim of this review was to report on the imaging modalities used to assess morphological and architectural properties of the m . triceps surae muscle in typically developing children, and the available reliability analyses. Scopus and MEDLINE (Pubmed) were searched systematically for all original articles published up to September 2020 measuring morphological and architectural properties of the m . triceps surae in typically developing children (18 years or under). Thirty eligible studies were included in this analysis, measuring fibre bundle length (FBL) ( n = 11), pennation angle (PA) ( n = 10), muscle volume (MV) ( n = 16) and physiological cross‐sectional area (PCSA) ( n = 4). Three primary imaging modalities were utilised to assess these architectural parameters in vivo : two‐dimensional ultrasound (2DUS n = 12), three‐dimensional ultrasound (3DUS n = 9) and magnetic resonance imaging (MRI n = 6). The mean age of participants ranged from 1.4 years to 18 years old. There was an apparent increase in m . gastrocnemius medialis MV and pCSA with age however, no trend was evident with FBL or PA. Analysis of correlations of muscle variables with age was limited by a lack of longitudinal data and methodological variations between studies affecting outcomes. Only five studies evaluated the reliability of the methods. Imaging methodologies such as MRI and US may provide valuable insight into the development of skeletal muscle from childhood to adulthood however, variations in methodological approaches can significantly influence outcomes. Researchers wishing to develop a model of typical muscle development should carry out longitudinal architectural assessment of all muscles comprising the m . triceps surae utilising a consistent approach that minimises confounding errors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-03-2022
Publisher: Springer Science and Business Media LLC
Date: 11-05-2022
DOI: 10.1038/S41598-022-11611-Z
Abstract: This study investigated morphological characteristics of the soleus muscle in cerebral palsy (CP) and typically developing (TD) cohorts using a statistical shape model and differentiated dominant features between the two cohorts. We generated shape models of CP and TD cohorts to characterize dominant features within each. We then generated a combined shape model of both CP and TD to assess deviations of the cohorts’ soleuses from a common mean shape, and statistically analysed differences between the cohorts. The shape models revealed similar principal components (PCs) with different variance between groups. The CP shape model yielded a distinct feature (superior–inferior shift of the broad central region) accounting for 8.1% of the model’s cumulative variance. The combined shape model presented two PCs where differences arose between CP and TD cohorts: size and aspect ratio of length–width–thickness. The distinct appearance characteristic in the CP model—described above—may implicate impaired muscle function in children with CP. Overall, children with CP had smaller muscles that also tended to be long, thin, and narrow. Shape modelling captures dominant morphological features of structures, which was used here to quantitatively describe CP muscles and further probe our understanding of the disease’s impact on the muscular system.
Publisher: Wiley
Date: 06-10-2017
DOI: 10.1016/J.PMRJ.2016.09.010
Abstract: Scapular orientation may be influenced by static body posture (sitting and standing) and contribute to the development of shoulder pain. Therefore, a consistent body posture should be considered when assessing scapular orientation as well as enhancing optimal scapular positioning. To determine whether there are differences in scapular orientation between standing, neutral sitting, and habitual sitting, while adjusting for spinal posture. A single group randomized repeated measures study. University laboratory. Twenty-eight participants with shoulder pain were recruited from the community. Scapular orientation between standing and seated positions was compared, with the arm by the side and at 120° of glenohumeral scaption. Thoracic kyphosis and lumbar lordosis angles were used as covariates. Scapular elevation, lateral translation, upward rotation, and posterior tilt. Scapular orientation was marginally but significantly different between sitting postures for lateral translation (mean 0.5 cm 95% confidence interval [95% CI] 0.2-0.7 cm) P < .001), upward rotation (mean 3° 95% CI 1.1-5.0° P < .001), and posterior tilt (mean 2.3° 95% CI 0.2-4.3° P = .009) in the arm by side position. A small-but-significant difference between standing and neutral sitting was found for upward rotation (mean 1.8° 95% CI 0-3.7° P = .02), and between standing and habitual sitting for lateral translation (mean 0.6 cm 95% CI 0-1.1 cm P =.02) in the arm by side position. The results of this study suggest that scapular orientation can be slightly affected by body posture, although the clinical relevance is uncertain. To enhance scapular upward rotation or posterior tilt, it may be preferable to place the patient in neutral sitting. Not applicable.
Publisher: Wiley
Date: 27-10-2021
DOI: 10.1111/DMCN.14714
Abstract: To investigate the use of ultrasound and magnetic resonance imaging (MRI) methodologies to assess muscle morphology and architecture in children with cerebral palsy (CP). A scoping review was conducted with systematic searches of Medline, Embase, Scopus, Web of Science, PubMed, and PsycInfo for all original articles published up to January 2019 utilizing ultrasound and/or MRI to determine morphological and architectural properties of lower limb skeletal muscle in children with CP. Eighty papers used ultrasound ( n =44), three‐dimensional ultrasound ( n =16), or MRI ( n =20) to measure at least one muscle parameter in children and adolescents with CP. Most research investigated single muscles, predominantly the medial gastrocnemius muscle, included children classified in Gross Motor Function Classification System levels I ( n =62) and II ( n =65), and assessed fascicle length ( n =35) and/or muscle volume ( n =35). Only 21 papers reported reliability of imaging techniques. Forty‐six papers assessed measures of Impairment ( n =39), Activity ( n =24), and Participation ( n =3). Current research study design, variation in methodology, and preferences towards investigation of isolated muscles may oversimplify the complexities of CP muscle but provide a foundation for the understanding of the changes in muscle parameters in children with CP. Current evidence is biased towards the medial gastrocnemius muscle and more functionally able children with cerebral palsy (CP). Variations in imaging techniques and joint positioning limit comparisons between studies. Clinimetric testing of parameters of CP muscle is not always considered. Assessment of parameter(s) of muscle with measures of participation is sparse.
Publisher: JMIR Publications Inc.
Date: 09-08-2022
DOI: 10.2196/34588
Abstract: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. The IM process resulted in the specification of app elements, self-determination theory–informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design.
Publisher: British Editorial Society of Bone & Joint Surgery
Date: 05-2023
DOI: 10.1302/2633-1462.45.BJO-2023-0005.R1
Abstract: To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity. Five databases (CENTRAL, CINAHL, PubMed, Embase, Web of Science) were systematically screened for studies investigating split tibialis anterior or split tibialis posterior tendon transfer for spastic equinovarus foot deformity, with gait-related outcomes (published pre-September 2022). Study quality and evidence were assessed using the Methodological Index for Non-Randomized Studies, the Risk of Bias In Non-Randomized Studies of Interventions, and the Grading of Recommendations Assessment, Development and Evaluation. Overall, 17 studies (566 feet) were included: 13 studies used clinical grading criteria to report a postoperative ‘success’ of 87% (75% to 100%), 14 reported on orthotic use with 88% reduced postoperative use, and one study reported on ankle kinematics improvements. Ten studies reported post-surgical complications at a rate of 11/390 feet (2.8%), but 84 feet (14.8%) had recurrent varus (68 feet, 12%) or occurrence of valgus (16 feet, 2.8%). Only one study included a patient-reported outcome measure (pain). Split tendon transfers are an effective treatment for children and youth with CP and spastic equinovarus foot deformities. Clinical data presented can be used for future study designs a more standardized functional and patient-focused approach to evaluating outcomes of surgical intervention of gait may be warranted. Cite this article: Bone Jt Open 2023 (5):283–298.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2022
DOI: 10.1186/S41256-022-00250-6
Abstract: Cerebral palsy (CP) registers serve as instrumental tools to support development of care pathways, preventative strategies, and health gains. Such health gains, however, are not always universal, with Indigenous health inequities common. To support Indigenous health, health registers need complete, consistent, and high-quality data. The aim of this study was to identify perceived barriers to the ascertainment of Indigenous peoples on health registers and to collate strategies supporting comprehensive ascertainment and achievement of high-quality Indigenous data. Environmental scanning methods were utilized within a Kaupapa Māori theoretical framework, which aims to produce research that is transformational and supportive of Indigenous health gain. Knowledge and insights were obtained from CP registers in countries with Indigenous populations and complemented by information from health registers in Aotearoa New Zealand (NZ). Data collection methods included an online survey and scan of organizational websites. Data extraction focused on general information about the register, barriers to ascertainment, and strategies to support ascertainment and high data quality. 52 registers were identified, 20 completed the survey and 19 included in the study (CP registers, n = 10, NZ health registers, n = 9). Web scan data were included for the other 32 registers (CP registers, n = 21, NZ health registers, n = 11). Indigenous health equity was identified in the visions and aims of only two health registers. Ethnicity data collection was identified in nearly three quarters of survey respondents and a limited number of organizational websites. Over half of survey respondents described system, health provider/service, or workforce barriers to ascertainment. Strategies were categorized into collaboration, health provider/service, workforce, and systems-levels. Indigenous-specific strategies were limited and focused on personal behaviour and access to registration. CP and other health registers can have a significant role in identifying and addressing Indigenous health inequities. However, this is not currently an overt priority for many registers in this study and few registers describe ascertainment and data quality strategies specific to Indigenous peoples. Significant opportunity exists for health registers to be accountable and to implement approaches to support Indigenous health equity, address structural determinants of inequities, and achieve health gain for all.
Publisher: Informa UK Limited
Date: 26-01-2019
Publisher: Wiley
Date: 20-08-2012
DOI: 10.1002/MUS.23326
Abstract: The purpose of this study was to establish the nature and stability of the strength-size relationship for the knee flexors and extensors across a 6-month period of childhood growth. Nineteen typically developing children aged 5-11 years underwent lower limb magnetic resonance imaging (MRI) and dynamometry strength assessments on 2 occasions, 6 months apart. Muscle volume (MV) and maximum anatomical cross-sectional area (aCSA) for the knee flexors and extensors were determined using MRI analysis software. Isokinetic dynamometry determined corresponding isometric and isokinetic strength. Strong correlations were found between muscle size and strength for both the knee flexors and extensors (r = 0.84-0.90 P < 0.01). Furthermore, the ratio of strength to muscle size remained consistent across 6 months of prepubescent growth. Increases in thigh muscle strength were relative to those in muscle size, suggesting that muscle growth may play an important role in the development of strength during childhood.
Publisher: Wiley
Date: 06-05-2023
DOI: 10.1111/DMCN.15622
Abstract: To identify the most frequently reported non‐instrumented measures of gait, activity, and participation in children with cerebral palsy (CP) after undergoing gait corrective orthopaedic surgery. Four databases were searched from database inception to the 9th December 2021 for studies that evaluated functional outcomes for children with CP under 18 years undergoing gait corrective orthopaedic surgery. Of 547 citations, 44 publications ( n = 3535 participants, n = 1789 males, mean age 10 years 5 months [SD = 3 years 3 months], Gross Motor Function Classification System levels I–III at the time of surgery) were eligible for inclusion. Fourteen different outcome measures were used: one measure of gait, 10 measures of activity, and three measures of participation. Gait was measured with the Edinburgh Visual Gait Scale (EVGS 4 out of 44). The most common activity and participation measures were the Functional Mobility Scale (FMS 15 out of 44) and Pediatric Outcomes Data Collection Instrument (11 out of 44) respectively. No studies reported a combination of gait, activity, and participation measures. The EVGS and FMS should be considered as core outcome measures in gait corrective orthopaedic surgery, while a measure of participation is unclear. Additional considerations for developing a comprehensive suite of outcomes include identifying a combination of clinical measures and performance‐reflective questionnaires that are standardized for children with CP undergoing surgery and meaningful to clinicians and families.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-068774
Abstract: For children with cerebral palsy (CP), who are marginally ambulant, gross motor capacity peaks between 6 and 7 years of age with a subsequent clinical decline, impacting their ability to engage in physical activity. Active Strides-CP is a novel package of physiotherapy targeting body functions, activity and participation outcomes for children with bilateral CP. This study will compare Active Strides-CP to usual care in a multisite randomised waitlist-controlled trial. 150 children with bilateral CP (5–15 years), classified in Gross Motor Function Classification System (GMFCS) levels III and IV will be stratified (GMFCS III vs IV, age 5–10 years 11–15 years and trial site) and randomised to receive either (1) 8 weeks of Active Strides-CP two times/week for 1.5 hours in clinic and one time/week for 1 hour alternating home visits and telehealth (total dose=32 hours) or (2) usual care. Active Strides-CP comprises functional electrical stimulation cycling, partial body weight support treadmill training, overground walking, adapted community cycling and goal-directed training. Outcomes will be measured at baseline, immediately post-intervention at 9 weeks primary endpoint and at 26 weeks post-baseline for retention. The primary outcome is the Gross Motor Function Measure-66. Secondary outcomes include habitual physical activity, cardiorespiratory fitness, walking speed and distance, frequency/involvement of community participation, mobility, goal attainment and quality of life. Analyses will follow standard principles for randomised controlled trials using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. A within-trial cost utility analysis will be performed. The Children’s Health Queensland Hospital and Health Service, The University of Queensland, The University of Melbourne and Curtin University Human Research Ethics Committees have approved this study. Results will be disseminated as conference abstracts and presentations, peer-reviewed articles in scientific journals, and institution newsletters and media releases. ACTRN12621001133820.
Publisher: Wiley
Date: 15-10-2018
DOI: 10.1002/MUS.26293
Abstract: In this study we aimed to determine the lower limb morphological characteristics of skeletal muscle of ambulant children with spastic cerebral palsy (CP) and typically developing (TD) children. Seventeen children with spastic diplegic CP (10 boys and 7 girls, 5-12 years of age, Gross Motor Function Classification System [GMFCS] level I or II) and 19 TD children (8 boys and 11 girls, 5-11 years of age) underwent lower limb T1-weighted MRI. Morphological characteristics of the triceps surae, including muscle volume, anatomical cross-sectional area, muscle length, and subcutaneous adipose tissue, were digitally quantified, and the proportional distribution calculated. Children with GMFCS II had significantly reduced muscle volume, cross-sectional area, and muscle length, and increased subcutaneous fat compared with TD children. Children classified as GMFCS II consistently exhibited the greatest deficits in all morphology variables. Morphological variables were significantly different between the groups. These alterations have the potential to influence the functional capabilities of the triceps surae muscle group. Muscle Nerve 58:818-823, 2018.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2019
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JSAMS.2018.05.025
Abstract: Examine the running kinematics in healthy, physically active prepubescent children and to determine if specific biomechanical factors correlate with running performance. Cross-sectional study. Fifteen children (age 9years, ±11months) completed a 1km time trial before undergoing three-dimensional running motion analysis. A strong positive correlation was observed between the biomechanical variables of stride length (p<.01), contact time (p<.01) and ankle dorsiflexion angle (p=.04) with time trial performance. Between variable analyses revealed a strong positive correlation between peak angles of hip adduction and knee flexion. There was no correlation between hip adduction and knee flexion peak angles or the vertical displacement of centre of mass with trial performance. The results of this study show that children with a better time trial performance display longer stride length, shorter contact time and mid or forefoot strike pattern. These findings have implications for targeted technique intervention in children's running training to improve running performance.
Publisher: Oxford University Press (OUP)
Date: 04-2016
DOI: 10.2522/PTJ.20150144
Abstract: The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression. The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position. An interrater and intratester reliability and validity study was conducted. Testing was conducted on the same day by 2 physical therapists who were blinded to each other's results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity. For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were & .9 mm, & .5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method. The results of this study are limited to static measurement of the scapula in one plane. Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-040108
Abstract: Determine the adherence to and effectiveness of an 8-week home exercise programme for children with disabilities delivered using Physitrack, an online exercise prescription tool, compared with traditional paper-based methods. Single-blinded, parallel-groups, randomised controlled trial (RCT). Intervention took place in participants’ homes in Western Australia. Children aged 6 to 17 years, with neurodevelopmental disabilities including cerebral palsy (CP), receiving community therapy services. All participants completed an in idualised home exercise programme, which was delivered to the intervention group using Physitrack and conventional paper-based methods for the control group. Adherence to exercise programme, goal achievement and exercise performance. Enjoyment, confidence and usability of Physitrack. Fifty-four participants with CP (n=37) or other neurodevelopmental disabilities (n=17) were recruited. Fifty-three were randomised after one early withdrawal. Forty-six completed the 8-week programme, with 24 in the intervention group and 22 in the control group. There was no difference between the two groups for percentage of exercises completed (intervention (n=22): 62.8% (SD 27.7), control (n=22): 55.8% (SD 19.4), between group mean difference −7.0% (95% CI: −21.6 to 7.5, p=0.34)). Both groups showed significant improvement in their self-rated performance of in idualised goal activities, however there was no statistically significant difference between groups for goal achievement, quality of exercise performance, enjoyment, confidence or preferred method of delivery. There were no adverse events. Physitrack provides a therapist with a new means of providing an exercise programme with online tools such as exercise videos, but our preliminary findings indicate that it may be no better than a traditional paper-based method for improving exercise adherence or the other outcomes measured. Exercise programmes remain an intervention supported by evidence, but a larger RCT is required to fully evaluate online delivery methods. Australian New Zealand Clinical Trials Registry ACTRN12616000743460.
Publisher: Wiley
Date: 22-06-2013
DOI: 10.1111/DMCN.12200
Abstract: With evidence for an atrophic effect of botulinum toxin type A (BoNT-A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT-A treatment. Fifteen children (10 males, five females age range 5-11y, mean age 8y 5mo, SD 1y 10mo) with spastic diplegic CP [Gross Motor Function Classification System Levels I (n=9) and II (n=6)] receiving BoNT-A injections for spasticity management were included. None of the children was a first-time receiver of BoNT-A. Magnetic resonance imaging and Mimics software assessed muscle volume, timed 2 weeks before and 5 weeks after injection. All participants received BoNT-A bilaterally to the gastrocnemius muscle, and five participants also received BoNT-A bilaterally to the medial hamstring muscles. Functional assessment measures used were the 6-Minute Walk Test (6-MWT), the Timed Up and Go (TUG) test, and hand-held dynamometry. Whilst total muscle group volume of the injected muscle group remained unchanged, a 4.47% decrease in the injected gastrocnemius muscle volume (p=0.01) and a 3.96% increase in soleus muscle volume (p=0.02) was evident following BoNT-A. There were no statistically significant changes in function after BoNT-A as assessed by the TUG. There was also no statistically significant change in distance covered in the 6-MWT. Muscle strength, as assessed using hand-held dynamometry was also not statistically different after BoNT-A treatment. Muscle volume decreases were observed in the injected muscle (gastrocnemius), with synergistic muscle hypertrophy that appeared to compensate for this decrement. The 4% to 5% decrease in the volume of BoNT-A injected muscles are not dramatic in comparison to reports in recent animal studies, and are a positive indication for BoNT-A, particularly as it also did not negatively alter function.
Publisher: Informa UK Limited
Date: 28-08-2013
DOI: 10.3109/09638288.2012.711898
Abstract: Investigate the combination effects of strength training and Botulinum Toxin Type-A (BoNT-A) on muscle strength and morphology in children with Cerebral Palsy (CP). Fifteen children receiving BoNT-A, classified as Spastic Diplegic CP, GMFCS I-II, and aged 5-12 years were recruited for this study. Randomly allocated to 10 weeks of strength training either before or after BoNT-A, children were assessed over 6 months. Eight of the 15 children also completed a control period. The Modified Ashworth Scale measured spasticity. The Goal Attainment Scale (GAS) assessed achievement of functional goals. Magnetic Resonance Imaging assessed muscle volume (MV). Instrumented dynamometry assessed strength. Spasticity was significantly reduced following BoNT-A injection (p = 0.033). Children made significant isokinetic strength gains (mean p = 0.022, ES = 0.57) in the intervention period compared to the control period (mean p = 0.15, ES = 0.56). Irrespective of timing, significant strength improvements were seen immediately (10 weeks) and over 6 months for all children. This was also the case for improvements in the GAS (immediately: mean p = 0.007, ES = 4.17, 6 months: mean p = 0.029, ES = 0.99), and improvements in MV in all assessed muscles. The simultaneous use of BoNT-A and strength training was successful in spasticity reduction, improving strength and achieving functional goals, over and above treatment with BoNT-A alone. Muscles targeted for BoNT-A injection should be included in strength training. Cerebral Palsy• Botulinum toxin type-A (BoNT-A) and strength training are available interventions that, on their own have found success in managing spasticity and muscle weakness (both significant motor impairments), respectively in children with Cerebral Palsy (CP). • This study has demonstrated that the concurrent treatment of BoNT-A and strength training can achieve positive outcomes in terms of strength, spasticity and for the achievement of set functional goals. • The results of this study show that the improved muscle strength can be associated with hypertrophy, which could indicate the potential role of strength training in altering the rate of muscle growth, in an aim to improve the failure of muscle growth associated with CP. • Home based strength training, based on a child's in idual goals is shown to be successful in improving strength and goal attainment for children with CP.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JSAMS.2017.06.022
Abstract: To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.
Publisher: Informa UK Limited
Date: 26-12-2012
DOI: 10.3109/09638288.2011.641662
Abstract: To measure activity, participation and QoL in children with CP and to determine how these differ from a comparable group of typically developing (TD) children. A total of eleven males and eight females with CP ranging in age from 5 to 12 years (mean age 7 years 10 months, SD 1 year 10 months GMFCS level I-II) and 19 age and sex matched TD peers were recruited. Activity was measured using Paediatric Activity Card Sort (PACS), 6-Minute Walk Test and Timed Up and Go Test (TUG). Participation was measured using the assessment of Life Habits (LIFE-H) and quality of life was measured using the Cerebral Palsy Quality of Life Questionnaire (CP-QoL). TD children performed more activities of personal care than children with CP, as assessed via the PACS, t(40) = 3.266, p = 0.002. TD children participate in more life habits than children with CP across all the LIFE-H domains except that of relationships. Results from the CP-QoL indicate that TD children experience a greater QoL in the domains of functioning, t(40) = 2.824, p = 0.007, and participation and physical health, t(40) = 3.543, p = 0.001, than children with CP. These findings encourage the development of therapeutic interventions that aim to reduce these imbalances at all levels of the International Classification of Functioning, Disability and Health.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.PTSP.2018.04.006
Abstract: The aim of this study was to investigate the effects of ankle taping on ankle and knee joint biomechanics during cutting and rebound activities in females. Cross-sectional. Laboratory. Twenty semi-professional female basketball players performed a cut and rebound task under two conditions (taped and no-tape). Kinematic and ground reaction force data were collected during the deceleration phase of each movement task. Taping resulted in a significant reduction in peak ankle dorsiflexion, inversion and internal rotation angles and range of motion (ROM) at the ankle joint and reduced knee ROM in the sagittal plane during the rebound task only. Taping significantly reduced peak knee flexion moment (0.29 Nm/kg, P = 0.013) and increased knee internal rotation moment (0.63 Nm/kg, P = 0.026) during the cutting task compared to control. Taping also significantly reduced the internal rotation moment (0.07 Nm/kg, P = 0.025), and medial shear forces (0.14 N/kg, P = 0.012) in the rebound task. Results of the study suggest that ankle taping restrict ankle range of movement in the rebound task only and ankle taping appears to have upstream effects on the knee, which may have injury implications.
Publisher: Wiley
Date: 06-03-2018
DOI: 10.1016/J.PMRJ.2018.02.017
Abstract: Isometric assessment of muscular function using a handheld dynamometer (HHD) is frequently used in clinic environments. However, there is controversy in terms of the validity of isometric assessment to monitor changes in dynamic performance. One repetition maximum (1RM) is considered the gold standard for evaluating dynamic strength, though clinicians do not often use 1RM testing, preferring to be cautious with clients who have preexisting impairments. If strength testing using an HHD could be used to predict 1RM, this may have significant implications for the use of isometric testing to prescribe exercise in clinical environments. To establish the relationship and agreement between 1RM and isometric strength scores measured using HHD for the biceps and quadriceps muscle groups and to determine if HHD measurements can be used to predict 1RM. Criterion standard comparison. Tertiary institution gymnasium. Convenience s le of 50 healthy adults (26 women) aged 19-33 years (mean 23.38 ± 3.11 years). Muscle strength of the biceps and quadriceps muscle groups measured by 1RM and isometric maximal voluntary contraction measured using an HHD. Statistical analysis of the relation between the measures of strength was established using Pearson correlation and a Bland-Altman plot. A linear regression analysis with included covariates (gender, age, resistance training history, and body mass index) was used to derive the prediction equations. A significant correlation was found between 1RM and HHD scores for the biceps (r = .83, P < .001) and quadriceps muscle groups (r = .82, P < .001). However, strength scores were not in agreement. Linear regression analysis found significance in predicting 1RM from all HHD scores (P < .001). Gender as a covariate significantly influenced the prediction of 1RM for the biceps (P = .005) and quadriceps (P = .003) muscle groups. There is a significant relationship between 1RM and HHD measures of strength, and measures taken using an HHD can be used to predict 1RM in the biceps and quadriceps muscle groups. The use of an HHD may therefore provide a more accessible alternative to 1RM for muscle strength assessments. Further research is warranted to determine if results are applicable in clinical populations. NA.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2022
DOI: 10.1038/S41598-022-23087-Y
Abstract: To assess intra-rater and inter-rater reliability of the manual segmentation of Magnetic Resonance Imaging (MRI) for the in vivo measurement of infant muscle volume of the knee extensor and flexor muscles by two raters. Muscles of the knee extensor and flexor muscle of ten typically developing infants (86 days ± 7 days) were scanned with MRI (Proton density sequence). Scans were then segmented using Slicer software, and volumes rendered by two raters. Intra-rater and inter-rater reliability were assessed using intra-class correlation (ICC), with mean difference (MD), standard error of the mean (SEM), and minimal detectable change (MDC) for each muscle calculated. ICCs for Intra-rater reliability of the segmentation process for the muscle volume of the muscles of the knee extensors and flexor muscles were 0.901–0.972, and 0.776–0.945 respectively, with inter-rater reliabilities between 0.914–0.954 and 0.848–0.978, for the knee extensor and flexors muscles respectively. For intra-rater reliability, MD ≤ − 0.47 cm 3 , MDCs for were 1.09 cm 3 and for inter-rater MD ≤ − 1.40 cm 3 , MDCs for were 1.63 cm 3 for all muscles. MRI segmentation for muscle volumes showed good to excellent reliability, though given the small volumes of the muscles themselves, variations between raters are lified. Care should be taken in the reporting and interpretation of infant muscle volume.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/PEP.0000000000000584
Abstract: To assess effects of adaptive bungee tr oline training for children with cerebral palsy. This was a single-subject intervention study, A-B-A, with 4 children aged 6 to 11 years. Measurements included muscle strength, balance, functional muscle strength, functional mobility, selected Gross Motor Function Measure items, heart rate, enjoyment, and for adverse effects—range of motion and spasticity. Goals were measured using the Canadian Occupational Performance Measure. Lower limb muscle strength improved in 3 children, and balance and functional strength in 2 children. The child who was not walking increased sitting and supported standing times. All participants had clinically significant increases on the Canadian Occupational Performance Measure. Adherence and enjoyment were high, with no adverse effects. Adaptive bungee tr oline training can improve strength, balance, and functional mobility in children with cerebral palsy.
Publisher: Oxford University Press (OUP)
Date: 17-12-2021
DOI: 10.1093/PTJ/PZAA208
Abstract: Serratus anterior (SA) muscle activation may be decreased with subacromial pain syndrome. The purpose of this study was to determine whether the addition of real-time ultrasound (RTUS) visual feedback increased activation of SA in adults with painful shoulders in comparison to manual facilitation alone. This assessor-blinded, 2-period, randomized cross-over trial was conducted in a university medical imaging laboratory. Adults with mild-moderate unilateral subacromial pain received both interventions in random order with at least 1-week washout between interventions. Fourteen participants were randomized to receive manual facilitation with RTUS first, and 13 were randomized to receive manual facilitation alone first. Fifteen repetitions of a supine ``serratus punch'' were facilitated by RTUS visual feedback with manual facilitation or by manual facilitation alone. Levels of SA activation via surface electromyography were normalized to a maximum voluntary isometric contraction. A total of 25 participants completed the full trial of both interventions. Data from 25 participant periods for RTUS with manual facilitation and data from 26 participant periods for manual facilitation only were analyzed. The predicted marginal mean difference between interventions was 55.5% (95% CI = 13.9% to 97.1%) in favor of the addition of RTUS feedback. No adverse effects occurred. RTUS visual feedback increases SA activation in adults with painful shoulders compared with manual facilitation alone. Determining if RTUS can improve SA muscle activation may help clinicians improve physical therapist interventions for subacromial pain syndrome.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2022
DOI: 10.1186/S12891-022-05110-5
Abstract: Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across in iduals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and in iduals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40–70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to in iduals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
Publisher: MDPI AG
Date: 16-02-2023
Abstract: A third of older adults will fall each year and many will not be injured. Getting up from the floor in a timely manner is important, however it is unclear what technique older adults use to get themselves up off the ground unassisted, whether there are differences between men and women in getting up and what functional joint kinematics are used to rise from the floor. This study included a convenience s le of 20 older adults (65+ years) to answer these questions. Participants completed a series of movement tasks (i.e., rising from the floor using their own technique, a specified technique, walking 10 m and five repeated sit-to-stands), with temporospatial and joint kinematic data captured using an 18-camera 3D Vicon motion analysis system. Results found three techniques preferred by participants the sit-up (n = 12), side-sit (n = 4) and the roll over (n = 4), with no differences found between sexes. The sit-up technique requires a higher degree of hip and knee flexion to complete compared to the side-sit and roll over. It may be beneficial for health professionals to work with older adults to identify their preferred technique for rising from the floor and encourage regular practice of this skill.
Publisher: BMJ
Date: 2018
Publisher: MDPI AG
Date: 31-03-2021
DOI: 10.3390/JCM10071398
Abstract: Listening to the family experience is integral to identifying areas of strength and for improvement in health service delivery around diagnosis and early management of cerebral palsy (CP). Families of children with a diagnosis of CP were invited to complete a purpose-developed electronic survey that included items around the timing of diagnosis, their experiences and satisfaction. It also allowed families to expand on their experiences through free text. Of the 57 families responding, 49% of children functioned at Gross Motor Function Classification System (GMFCS) levels I or II, 8% at GMFCS level III and 23% at GMFCS levels IV or V. 51% of participants were satisfied or very satisfied with the diagnosis experience, 18% were neutral about the experience and 31% were dissatisfied or very dissatisfied. Though the findings of this study may be subject to selection bias, perceived delays in the receipt of diagnosis of CP appeared common with 60% of participants indicating concerns about their child by months of age but only 21% provided with a diagnosis of CP months of age. Approximately 18% of families experienced a delay of more than 12 months. Thirty-four (61%) participants noted a delay between referrals to a service and receipt of service management/therapy. Common themes impacting on families’ experience in the diagnosis and health service delivery journey related to provision of information, and the style of communication, with both direct and ongoing communication styles common for greater family satisfaction. Overall, families desired the diagnosis experience to be informative and timely, with early follow up support and assistance with health sector navigation.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2022
DOI: 10.1186/S12939-022-01635-2
Abstract: Health registers play an important role in monitoring distribution of disease and quality of care however, benefit is limited if ascertainment (i.e., the process of finding and recruiting people on to a register) and data quality (i.e., the accuracy, completeness, reliability, relevance, and timeliness of data) are poor. Indigenous peoples experience significant health inequities globally, yet health data for, and about, Indigenous peoples is often of poor quality. This narrative review aimed to (i) identify perceived barriers for the ascertainment of Indigenous peoples on health registers, and (ii) collate strategies identified and used by health registers to support comprehensive ascertainment and high-quality data for Indigenous peoples. A Kaupapa Māori theoretical framework was utilized to guide this work. Four electronic databases were systematically searched for original articles and screened for eligibility. Studies involving health registers with Indigenous population(s) identified were included if either ascertainment or data quality strategies were described. Data extraction focused on the reporting of research involving Indigenous peoples using the CONSIDER checklist domains, ascertainment, and data quality. Seventeen articles were included spanning publication between 1992 and 2020. Aspects of four of eight CONSIDER domains were identified to be included in the reporting of studies. Barriers to ascertainment were themed as relating to ‘ ethnicity data collection and quality’ , ‘ systems and structures’ , ‘ health services/health professionals’ , and ‘ perceptions of in idual and community-level barriers ’. Strategies to support ascertainment were categorized as ‘ collaboration ’, ‘ finding people’ , and ‘ recruitment processes ’. Categorized strategies to support data quality were ‘ collaboration ’, ‘ ethnicity data collection and quality ’, ‘ systems-level strategies’ , and ‘ health service/health professional-level strategies ’. Poor-quality data for Indigenous peoples in health registers prevents the achievement of health equity and exemplifies inaction in the face of need. When viewed through a critical structural determinants lens, there are visible gaps in the breadth of strategies, particularly relating to the inclusion of Indigenous peoples in health register and research governance, and actions to identify and address institutional racism. Indigenous led research, meaningful collaboration, and a sharing of knowledge and experiences between health registers is recommended to enable research and health registers that support Indigenous self-determination and health equity.
Publisher: MDPI AG
Date: 28-03-2022
DOI: 10.3390/JCM11071866
Abstract: Cerebral palsy is a common cause of physical disability. The New Zealand Cerebral Palsy Register (NZCPR) was established in 2015 and reports national data. Internationally, an early CP diagnosis has been a focus, with imaging and clinical tools used to enable early accurate detection. Accordingly, guidelines are being developed for New Zealand, including a specific pathway for high-risk neonatal intensive care (NICU) graduates, reflecting the high rate of CP in this group. To inform this work, we reviewed imaging data from a retrospective NICU cohort identified from the NZCPR. In these 140 in iduals with CP and a confirmed NICU admission during 2000–2019 inclusive, imaging frequency, modality, and rate of abnormality was determined. Overall, 114 (81.4%) had imaging performed in the NICU, but the frequency and modality used varied by gestational subgroup. For infants born at less than 32 weeks gestation, 53/55 had routine imaging with ultrasound, and IVH was graded as none or mild (grade 1–2) in 35 or severe (grade 3–4) in 18 infants. For the 34 infants born between 32–36 weeks gestation, only 13/19 imaged in the NICU were reported as abnormal. For 51 term-born infants, 41/42 imaged in the NICU with MRI had abnormal results.
Publisher: Cold Spring Harbor Laboratory
Date: 16-07-2022
DOI: 10.1101/2022.07.13.499984
Abstract: The presence of abnormal infant General Movements (GMs) is a strong predictor of progressive neurodevelopmental disorders, including cerebral palsy (CP). Automation of the assessment will overcome scalability barriers that limit its delivery to at-risk in iduals. Here, we report a robust markerless pose-estimation scheme, based on advanced deep-learning technology, to track infant movements in consumer mobile device video recordings. Two deep neural network models, namely Efficientnet-b6 and resnet152, were trained on manually annotated data across twelve anatomical locations (3 per limb) in 12 videos from 6 full-term infants (mean age = 17.33 (SD 2.9) wks, 4 male, 2 female), using the DeepLabCut ™ framework. K -fold cross-validation indicates the generalization capability of the deep-nets for GM tracking on out-of-domain data with an overall performance of 95.52% (SD 2.43) from the best performing model (Efficientnet-b6) across all infants (performance range: 84.32– 99.24% across all anatomical locations). The paper further introduces an automatic, unsupervised strategy for performance evaluation on extensive out-of-domain recordings through a fusion of likelihoods from a Kalman filter and the deep-net. Findings indicate the possibility of establishing an automated GM tracking platform, as a suitable alternative to, or support for, the current observational protocols for early diagnosis of neurodevelopmental disorders in early infancy.
Publisher: Wiley
Date: 24-10-2021
DOI: 10.1111/JOA.13565
Abstract: This study assessed the intra‐acquirer, intra‐ and inter‐processor reliability, and validity of the in vivo assessment of the medial gastrocnemius (MG), lateral gastrocnemius (LG) and soleus (SOL) muscle volumes using freehand 3D ultrasound (3DUS) in typically developing infants. Reliability assessments of freehand 3DUS were undertaken in infants across three ages groups: three, six and twelve months of age, with validity testing completed against magnetic resonance imaging (MRI) in infants at 3 months of age. Freehand 3DUS scanning was carried out by a single acquirer, with two independent processors manually segmenting images to render volumes. MRI images were segmented independently by a separate processor, with the volumes compared to those obtained via freehand 3DUS. Reliability was assessed using intraclass correlation (ICC), coefficient of variance (CV) and minimal detectable change (MDC) across each assessment time point. Validity was assessed using the limits of agreement. ICCs for intra‐acquirer reliability of the acquisition process for freehand 3DUS ranged from 0.91 to 0.99 across all muscles. ICCs for intra‐processor and inter‐processor reliability for the segmentation process of freehand 3DUS ranged from 0.80 to 0.98 across all muscles. Acceptable levels of agreement between muscle volume obtained by freehand 3DUS and MRI were found for all muscles however, freehand 3DUS overestimated muscle volume of MG and LG and underestimate the SOL compared with MRI, with average absolute differences of MG = 0.3 ml, LG = 0.3 ml and Sol = 1.2 ml. Freehand 3DUS is a reliable method for measuring in vivo triceps surae muscle volume in typically developing infants. We conclude that freehand 3DUS is a useful tool to assess changes in muscle volume in response to growth and interventions in infants.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2018
Publisher: Wiley
Date: 20-11-2021
DOI: 10.1111/JPC.15263
Abstract: A diagnosis of cerebral palsy (CP) can, and should, be made as early as possible. This work describes current clinical practice around the awareness and use of diagnostic tools for the detection of CP in New Zealand (NZ). A purpose‐developed survey distributed electronically to NZ clinicians working with young children with or at risk of CP. A total of 159 clinicians (including paediatricians, physiotherapists and occupational therapists) participated in this cross‐sectional study. Ninety‐six percent were aware that a diagnosis of CP can be made by 12 months of age, with high levels of awareness of the use of magnetic resonance imaging (94%), Prechtl's qualitative assessment of general movements (GMs) (70%) and Hammersmith Infant Neurological Examination (HINE) (77%). Only 40% were aware of the HINE optimality scoring. Fifty‐four clinicians provided a diagnosis of CP as part of their role: 48% never used the GMs or HINE to assess children year, and 57% never used the HINE for children between 1 and 2 years. Clinicians not providing a diagnosis within their professional role ( n = 104) also indicated infrequent use of assessment tools with 74% and 54% never using the GM's or HINE (respectively) in their assessment of children at risk of CP. Barriers to use included lack of time and funding, lack of clear pathways and management support. Despite high awareness, current use of international best practice tools in NZ clinical practice appears low. Multiple barriers are reported to the use of these tools, which need to be addressed to improve the timeliness of diagnosis.
Publisher: Informa UK Limited
Date: 10-10-2023
No related grants have been discovered for Sian A Williams.