Abstract Background The aim of this study is to contribute to the knowledge base on the long-term outcomes of evidence-based medical interventions used to improve gross motor function in children and adolescents with Cerebral Palsy. Method Prospective cohort study of children with Cerebral Palsy in the birth years 2000–2009 attending a tertiary level service for children with Cerebral Palsy who’s first recorded Gross Motor Function Classification System level was II. Results A total of 40 children were eligible for the study, of whom 28 (72.7%) enrolled. The Botulinum toxin A treatment for this cohort, (median and interquartile ranges) were: total number of lower limb Botulinum toxin A injections 11 (6.7, 5.5); total dose of Botulinum Toxin A per lower limb treatment 6.95 u/kg (4.5, 11); and dose of Botulinum Toxin u/kg/muscle 2.95 (2.2, 4). For all 28 subjects there was a median of 15 (8.5 to 22) Gross Motor Function Classification System level recordings: six of the 28 children (21.4%) improved from level II to level I, the remaining 22 children remained stable at level II (78.6%). In this highly treated population, the average 66 item Gross Motor Function Measure score for the 22 children in level II was 72.55, which is consistent with the mean of 68.5 reported in the original Ontario cohort. Conclusion This cohort study has confirmed that children with Cerebral Palsy, Gross Motor Function level II treated at a young age with repeated doses of Botulinum Toxin A within an integrated comprehensive service, maintain or improve their functional motor level at a later age.
To demonstrate the application of the constructs of treatment fidelity for research and clinical practice for motor speech disorders, using the Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Fidelity Measure (PFM). Treatment fidelity refers to a set of procedures used to monitor and improve the validity and reliability of behavioral intervention. While the concept of treatment fidelity has been emphasized in medical and allied health sciences, documentation of procedures for the systematic evaluation of treatment fidelity in Speech-Language Pathology is sparse.The development and iterative process to improve the PFM, is discussed. Further, the PFM is evaluated against recommended measurement strategies documented in the literature. This includes evaluating the appropriateness of goals and objectives; and the training of speech-language pathologists, using direct and indirect procedures. Three expert raters scored the PFM to examine inter-rater reliability.Three raters, blinded to each other's scores, completed fidelity ratings on three separate occasions. Inter-rater reliability, using Krippendorff's Alpha, was >80% for the PFM on the final scoring occasion. This indicates strong inter-rater reliability.The development of fidelity measures for the training of service providers and treatment delivery is important in specialized treatment approaches where certain 'active ingredients' (e.g. specific treatment targets and therapeutic techniques) must be present in order for treatment to be effective. The PFM reflects evidence-based practice by integrating treatment delivery and clinical skill as a single quantifiable metric. PFM enables researchers and clinicians to objectively measure treatment outcomes within the PROMPT approach.
Abstract. The term speech sound disorder describes a range of speech difficulties in children that affect speech intelligibility. Differential diagnosis is difficult and reliant on access to validated and reliable measures. Technological advances aim to provide clinical access to measurements that have been identified as beneficial in diagnosing speech disorders. To generate objective measurements and, consequently, automatic scores, the output from multi-camera networks is required to produce quality results. The quality of photogrammetric results is usually expressed in terms of the precision and reliability of the network. Precision is determined at the design stage as a function of the geometry of the network. In this manuscript, we focus on the design of a photogrammetric camera network using three cameras. We adopted a similar workflow as Alsadika et al. (2012) and tested serval network configurations. As the distances from the camera stations to object points were fixed to 3500mm, only the horizontal and vertical placements of the cameras were varied. Horizontal angles were changed within an increment of 10º, and vertical angles were changed within an increment of 5º. The object space coordinates of GCPs for each camera configuration were assessed in terms of horizontal error ellipses and vertical precision. The best design was the maximum horizontal and vertical convergence angles of 90° and 30°. The existing camera network used to capture videos for speech assessment was approximately as good as the top third of tested designs. However, from a validation perspective, it can be concluded that the design is viable for continued use.
Background and objectives: To conduct a systematic review of the evidence for the management of tone in infants 0–24 months of age, with or at risk of developing cerebral palsy. Method: This review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, CINAHL Plus and PsycINFO databases were systematically searched for relevant articles. Inclusion criteria were: children aged 0–24 months, identified as at risk of, or having cerebral palsy; ≥25% of participants ≤24 months, and included a standardized assessment of tone. Only peer reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the PEDro scale for randomized controlled trials and the checklist for assessing the quality of quantitative studies of Kmet, Cook and Lee for non-randomized control trials. Results: A total of 4838 studies were identified. After removing duplicates and unrelated studies, a total of 56 full text studies were reviewed. A total of five studies met inclusion criteria, two of which were RCTs, two pre-/post-test designs and one retrospective case audit. Interventions included BoNT-A, Oral Baclofen, Neurofacilitation of Developmental Reaction and Neurodevelopmental Therapy. The quality of evidence ranged from limited to moderate. Conclusion: The management of tone in infants and young children is not well described, with a dearth of high-level evidence to support intervention in the 0–24 month age-range. This is in contrast to a recent review completed by Novak et al. (2013) who report high levels of evidence of interventions for children with cerebral palsy, over 2 years of age.Implications for RehabilitationHigh level of evidence to support clinical decision making for the management of tone in young children 0–24 months is not available.The lack of available evidence in the management of tone of young children underpins service delivery and intervention and impacts on patient outcomes.In the absence of clear research evidence, the systematic application of sensitive outcome measures is required to confirm treatment effects and generate new evidence.Hypertonia should not be managed in isolation. Consideration needs to be given to all components of the ICF-CY.
Introduction The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life. Method and analysis Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies’ GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden. Ethics and dissemination Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739). Trial registration number ACTRN12619001422112.
This paper presents findings of a study of high school students participating in a tablet PC (TPC) programme. Primary areas of interest were students' experiences with and attitudes about the TPCs, physical discomfort associated with use of TPCs and temporal and task-driven patterns of TPC use. Data were collected via questionnaire and computer use-monitoring software. Results showed students' attitudes were generally quite positive towards the TPCs, although they did not tend to think TPCs had improved their grades, few disagreed that TPCs were a distraction in class, and visual and musculoskeletal discomfort was prevalent. Understanding how to use the TPC and recognizing its organizational capacity were associated with several positive attitudes towards the TPC, including making school more enjoyable. Children's exposure to computers will only increase, so study of the many dimensions of their impact is critical in order to understand what is effective, constructive and healthful for children.
This study evaluates kinematic movements of the jaw and lips in six children (3–11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech (PROMPT) intervention program. An ABCA single subject research design was implemented. Subsequent to the baseline phase (A), phase B targeted each participant's first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. A reference group of 12 typically-developing peers, age- and sex-matched to each participant with CP, was recruited for comparison in the interpretation of the kinematic data. Jaw and lip measurements of distance, velocity, and duration, during the production of 11 untrained stimulus words, were obtained at the end of each study phase using 3D motion analysis (Vicon Motus 9.1). All participants showed significant changes in specific movement characteristics of the jaw and lips. Kinematic changes were associated with significant positive changes to speech intelligibility in five of the six participants. This study makes a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech intelligibility in children with cerebral palsy.
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
