Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society
Delgado M.R.,University of Texas Southwestern Medical Center |
Hirtz D.,U.S. National Institutes of Health |
Aisen M.,United Cerebral Palsy Research Foundation |
Ashwal S.,Loma Linda University |
And 6 more authors.
Neurology | Year: 2010
OBJECTIVE: To evaluate published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. METHODS: A multidisciplinary panel systematically reviewed relevant literature from 1966 to July 2008. RESULTS: For localized/segmental spasticity, botulinum toxin type A is established as an effective treatment to reduce spasticity in the upper and lower extremities. There is conflicting evidence regarding functional improvement. Botulinum toxin type A was found to be generally safe in children with cerebral palsy; however, the Food and Drug Administration is presently investigating isolated cases of generalized weakness resulting in poor outcomes. No studies that met criteria are available on the use of phenol, alcohol, or botulinum toxin type B injections. For generalized spasticity, diazepam is probably effective in reducing spasticity, but there are insufficient data on its effect on motor function and its side-effect profile. Tizanidine is possibly effective, but there are insufficient data on its effect on function and its side-effect profile. There were insufficient data on the use of dantrolene, oral baclofen, and intrathecal baclofen, and toxicity was frequently reported. RECOMMENDATIONS: For localized/segmental spasticity that warrants treatment, botulinum toxin type A should be offered as an effective and generally safe treatment (Level A). There are insufficient data to support or refute the use of phenol, alcohol, or botulinum toxin type B (Level U). For generalized spasticity that warrants treatment, diazepam should be considered for short-term treatment, with caution regarding toxicity (Level B), and tizanidine may be considered (Level C). There are insufficient data to support or refute use of dantrolene, oral baclofen, or continuous intrathecal baclofen (Level U). Copyright © 2010 by AAN Enterprises, Inc.
Fuentes A.,York University |
McKay C.,Bloorview Kids Rehab |
Hay C.,Bloorview Kids Rehab
Brain Injury | Year: 2010
Primary objective: The current study examined the relationship between neuropsychological performance and cognitive reserve (as measured by word reading and vocabulary tasks) in children with TBI. Research design: Retrospective records analysis of the neuropsychological test results of 52 participants with medically documented traumatic brain injuries, ranging from 616 years of age. Main outcome and results: Indicators of cognitive reserve were not correlated with the majority of well-recognized neuropsychological measures. Conclusions: Although past research has found that verbal ability is a valid indicator of CR in adult populations, the present study found evidence against the validity of this traditional reserve proxy when applied to the paediatric population. These findings suggest one of two conclusions: (1) measures used to indicate CR in adult populations (word reading, vocabulary) are not valid indicators of cognitive reserve in paediatric populations; and/or (2) the measures themselves are valid, yet there is simply not a significant relationship between cognitive reserve and short-term (i.e. less than 6 months) neuropsychological outcome in paediatric TBI. © 2010 Informa UK Ltd.
Quillsoft Ltd., Holland Bloorview Kids Rehabilitation Hospital and Bloorview Kids Rehab | Date: 2015-03-11
Quillsoft Ltd., Holland Bloorview Kids Rehabilitation Hospital and Bloorview Kids Rehab | Date: 2011-04-12
computer software for speech recognition, converting speech to text, used in conjunction with other software that provides word prediction and text to speech, for use in the fields of writing, learning and education; speech recognition computer software providing visual and audible prompts for use with any software involving text input, for use in the fields of writing, learning and education.
Carpe A.,Lifemark Health Management Inc. |
Harder K.,Bridgepoint Health |
Tam C.,Bloorview Kids Rehab |
Reid D.,University of Toronto
Assistive Technology | Year: 2010
Children with physical disabilities (CPD) often experience decreased opportunities to participate in daily occupations. Occupational therapists (OTs) prescribe writing and communication aids; however, little is known about this population's perceptions of the technology. This qualitative study explored the perceptions that CPD had regarding their writing and communication aids. Children were interviewed; a focus group of one parent and two OTs provided context to the children's comments. Enablers and barriers to using communication aids were found. Participants reported a greater sense of pride, more self-confidence, and a greater sense of autonomy and productivity with the technology. Analysis of the interviews, focus group, and reflective notes resulted in a model showing how enablers and barriers of on-screen technology usage relates to occupational enhancement or occupational detriment. This study contributes to an understanding of the meaning that CPD associate with writing technology and the factors associated with usage. Copyright © 2010 RESNA.
Michalski A.,University of Toronto |
Glazebrook C.M.,University of Toronto |
Martin A.J.,University of Toronto |
Wong W.W.N.,University of Toronto |
And 7 more authors.
Gait and Posture | Year: 2012
The Nintendo Wii Fit™ may provide an affordable alternative to traditional biofeedback or virtual reality systems for retraining or improving motor function in populations with impaired balance. The purpose of this study was to evaluate postural control strategies healthy individuals use to play Wii Fit™ videogames. Sixteen young adults played 10 trials of . Ski Slalom and . Soccer Heading respectively. Centre of pressure (COP) excursion and three-dimensional movement data were acquired to determine variability in medial-lateral COP sway and shoulder-pelvic movement. While there was no difference in medial-lateral COP variability between games during trial 1, there was a significant difference after 10 trials. COP sway increased (59-75. mm) for . Soccer Heading while it decreased (67-33. mm) for . Ski Slalom from trial 1 to trial 10. During . Ski Slalom participants demonstrated decreased shoulder and pelvic movement combined with increased pelvic-shoulder coupling. Conversely, participants demonstrated greater initial shoulder tilt when playing . Soccer Heading, with no reduction in pelvic rotation and tilt. Participants decreased pelvic and trunk movements when skiing, suggesting a greater contribution of lower extremity control while they primarily used a trunk strategy to play . Soccer Heading. © 2012 Elsevier B.V.
Young N.L.,Laurentian University |
Young N.L.,The Hospital for Sick Children |
Rochon T.G.,Laurentian University |
McCormick A.,The Childrens Hospital for Eastern Ontario |
And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2010
Young NL, Rochon TG, McCormick A, Law M, Wedge JH, Fehlings D. The health and quality of life outcomes among youth and young adults with cerebral palsy. Objectives: To describe the health and quality of life (QoL) of youth and young adults who have cerebral palsy (CP), and to assess the impact of 3 key factors (severity, age, and sex) on these outcomes. Design: Cross-sectional survey. Setting: Participants were identified from 6 children's treatment centers in Ontario. Participants: The sample of participants (N=199) included youth (n=129; age, 13-17y) and adults (n=70; age, 23-33y) with a broad range of severity: 35% mild, 19% moderate, and 47% severe. Intervention: Not applicable. Main Outcome Measures: Health Utilities Index (HUI3), Assessment of Quality of Life (AQoL), and Self-Rated Health (SRH). Results: SRH was reported to be excellent or very good by 57% of youth and 46% of adults. Mean HUI3 scores were .30 for youth and .31 for adults. Mean AQoL scores were .28 for youth and adults. Severity of CP in childhood predicted 55% of the variance in HUI3 scores and 45% of the variance in AQoL scores. Age and sex were not significant predictors of health or QoL. Conclusions: The observed health and QoL scores were much lower than those previously reported in the literature. This is likely a result of the inclusion of those with severe CP. The scores for youth were similar to those for adults and suggest that health and QoL outcomes were relatively stable across the transition to adulthood. Youth and adults with CP have limited health status and will require health care support throughout their lives to help them optimize their well being. Longitudinal follow-up studies are essential to understand better the patterns of health in this population over time. © 2010 American Congress of Rehabilitation Medicine.
Torres-Solis J.,Bloorview Kids Rehab |
Torres-Solis J.,University of Toronto |
Chau T.,Bloorview Kids Rehab |
Chau T.,University of Toronto
Pervasive and Mobile Computing | Year: 2010
We introduce a wearable pedestrian indoor localization system with dynamic position correction. The system uniquely combines dead reckoning and fiducial marker-based localization schemes, exclusively using widely available, low end and low power consumer hardware components. The proposed system was tested with various walking patterns inside a building, achieving an indoor positioning accuracy of 3.38% of the total distance walked. This accuracy is comparable to those obtained with solutions deploying specialized high cost hardware components. The low cost wearable system proposed herein could serve as the foundation for a pervasive solution for indoor way finding and patient tracking. © 2010 Published by Elsevier B.V. All rights reserved.
Gan C.,Bloorview Kids Rehab |
Gargaro J.,Bloorview Kids Rehab |
Kreutzer J.S.,Virginia Commonwealth University |
Boschen K.A.,University of Toronto |
Wright F.V.,Bloorview Research Institute
Brain Injury | Year: 2010
Primary objective: To develop and conduct a preliminary evaluation of a manualized family system intervention for adolescents with acquired brain injury (ABI). Research design: Descriptive/exploratory design using mixed methods: modified-Delphi technique, self-administered questionnaires and semi-structured interviews. Methods and procedures: Topic modules and content areas for the adolescent version (BIFI-A) were developed, building on topic areas from the empirically-based Brain Injury Family Intervention (BIFI) for adults. Eight adolescents with ABI, their families and three clinicians who implemented the BIFI-A participated in evaluation of the BIFI-A. Evaluation data were obtained from all participants at the end of each session and post-intervention. Content validity of the revised version was formally evaluated. Main outcomes and results: A seven-session curriculum, focusing on education, skill building and emotional support, was developed and tested. Clinical utility evaluation survey results indicated 81-89% mean agreement, with positive statements rating helpfulness, importance, relevance, and satisfaction with the BIFI-A. Ninety per cent of adolescent, family and clinician participants said they would recommend the intervention to families of adolescents with an ABI. Survey and qualitative findings from families and test clinicians were used to refine the BIFI-A into a 12-session curriculum. Conclusions: The findings provide evidence that BIFI-A is a promising family system intervention. Additional research is needed to determine its benefits. © 2010 Informa UK Ltd All rights reserved.
Bloorview Kids Rehab | Date: 2010-06-29
Computer hardware and software for translating physical movement of individuals into music; devices used in translating physical movement of individuals into music, namely, cameras, webcameras, joysticks, computer styluses, computer keyboards, pointing devices, namely, computer mouses, electronic pens; midi devices, namely, audio speakers, sound modules for reproducing and creating sound, camera tripods, televisions and video projectors. Midi devices, namely, electronic musical instruments and sound modules for use in association with musical instruments.