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.
Falk T.H.,Bloorview Research Institute |
Falk T.H.,University of Toronto |
Chan J.,Bloorview Research Institute |
Duez P.,Bloorview Research Institute |
And 3 more authors.
IEEE Transactions on Neural Systems and Rehabilitation Engineering | Year: 2010
A binary switch based on the detection of periodic vocal cord vibrations is proposed for individuals with multiple and severe disabilities. The system offers three major advantages over existing speech-based access technologies, namely, insensitivity to environment noise, increased robustness against user-generated artifacts such as coughs, and reduced exertion during prolonged usage periods. The proposed system makes use of a dual-axis accelerometer placed noninvasively in proximity of the vocal cords by means of a neckband. Periodic vocal cord vibrations are detected using the normalized cross-correlation function computed from anteriorposterior and superiorinferior accelerometry signals. Experiments with a participant with hypotonic cerebral palsy show the proposed system outperforming a popular commercial sound-based system in terms of sensitivity, task time, and user-perceived exertion. © 2010 IEEE.
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.
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.