Saint Paul, MN, United States
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Leiser K.,Gillette Childrens Specialty Healthcare | Heffelfinger A.,Medical College of Wisconsin | Kaugars A.,Marquette University
Clinical Neuropsychologist | Year: 2017

Objective: To examine associations among parent–child relationship characteristics and child cognitive and language outcomes. Methods: Preschool children (n = 72) with early neurological insult completed assessments of cognitive and language functioning and participated in a parent–child semi-structured interaction. Results: Quality of the parent–child relationship accounted for a significant amount of unique variance (12%) in predicting children’s overall cognitive and language functioning. Impact of neurological insult was a significant predictor. Conclusions: Caregiver–child interactions that are harmonious and reciprocal as evidenced by affective and/or verbal exchanges support children’s cognitive and language development. Observations of interactions can guide providers in facilitating child- and family-centered interventions. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

Drummond A.,Gillette Childrens Specialty Healthcare | Looman W.S.,University of Minnesota | Phillips A.,Minnesota Gastroenterology
Journal of Pediatric Health Care | Year: 2012

Introduction: Having a health care home has been shown to be associated with positive health outcomes for children with special health care needs (CSHCN), but its relationship to parental coping has not been established. The purpose of this study was to explore the health care home as a process of care related to parental coping with day-to-day demands of raising a CSHCN. Method: Data are from a sample of 18,352 CSHCN in the 2007 National Survey of Children's Health. Using the Behavioral Model of Health Services Use as a framework, this secondary analysis explored relationships between child and household factors and parental coping among CSHCN with and without a health care home. Results: CSHCN in a health care home were more likely to have parents who were coping well. Parents who received sufficient care coordination were more satisfied with provider communication, and those who reported that care was family-centered reported better coping. Discussion: Results suggest that the health care home represents a process of care that may help families manage the daily demands of caring for CSHCN through family-centered care, provider-to-provider communication, and provision of care coordination. © 2012 National Association of Pediatric Nurse Practitioners.

Rozumalski A.,Gillette Childrens Specialty Healthcare | Rozumalski A.,University of Minnesota | Schwartz M.H.,Gillette Childrens Specialty Healthcare | Schwartz M.H.,University of Minnesota
Gait and Posture | Year: 2011

This article introduces a new index, the GDI-Kinetic; a direct analog of the GDI based on joint kinetics rather than kinematics. The method consists of: (1) identifying " features" of the raw gait kinetic data using singular value decomposition, (2) identifying a subset of features that account for a large percentage of the information in the raw gait kinetic data, (3) expressing the raw data from a group of typically developing children as a linear combination of these features, (4) expressing a subject's raw data as a linear combination of these features, (5) calculating the magnitude of the difference between the subject and the mean of the control, and (6) scaling and transforming the difference, in order to provide a simple, and statistically well-behaved, measure. Linear combinations of the first 20 gait features produced a 91% faithful reconstruction of the data. Concurrent and face validity for the GDI-Kinetic are presented through comparisons with the GDI, Gillette Functional Assessment Questionnaire Walking Scale (FAQ), and topographic classifications within the diagnosis of Cerebral Palsy (CP). The GDI-Kinetic and GDI are linearly related but not strongly correlated (r 2=0.24). Like the GDI, the GDI-Kinetic scales with FAQ level, distinguishes levels from one another, and is normally distributed across FAQ levels six to ten, and among typically developing children. The GDI-Kinetic also scales with respect to clinical involvement based on topographic CP classification in Hemiplegia types I-IV, Diplegia, Triplegia, and Quadriplegia. The GDI-Kinetic complements the GDI in order to give a more comprehensive measure of gait pathology. © 2011 Elsevier B.V.

Barney C.C.,Gillette Childrens Specialty Healthcare
Developmental Medicine and Child Neurology | Year: 2015

This commentary is on the original article by Valkenburg et al. on pages 1049-1055 of this issue. Developmental Medicine and Child Neurology. © 2015 Mac Keith Press.

Novotny S.A.,Gillette Childrens Specialty Healthcare | Warren G.L.,Georgia State University | Hamrick M.W.,Georgia Regents University
Physiology | Year: 2015

Aging-induced declines in muscle size and quality are thought to contribute to catabolic alterations in bone, but changes in bone with age also profoundly alter its response to muscle-derived stimuli. This review provides an overview of some of the alterations that occur in muscle and bone with aging, and discusses the cellular and molecular mechanisms that may impact these ageassociated changes. © 2015 Int. Union Physiol. Sci./Am. Physiol. Soc.

van der Krogt M.M.,VU University Amsterdam | van der Krogt M.M.,University of Twente | Delp S.L.,Stanford University | Schwartz M.H.,Gillette Childrens Specialty Healthcare | Schwartz M.H.,University of Minnesota
Gait and Posture | Year: 2012

Humans have a remarkable capacity to perform complex movements requiring agility, timing, and strength. Disuse, aging, and disease can lead to a loss of muscle strength, which frequently limits the performance of motor tasks. It is unknown, however, how much weakness can be tolerated before normal daily activities become impaired. This study examines the extent to which lower limb muscles can be weakened before normal walking is affected. We developed muscle-driven simulations of normal walking and then progressively weakened all major muscle groups, one at the time and simultaneously, to evaluate how much weakness could be tolerated before execution of normal gait became impossible. We further examined the compensations that arose as a result of weakening muscles. Our simulations revealed that normal walking is remarkably robust to weakness of some muscles but sensitive to weakness of others. Gait appears most robust to weakness of hip and knee extensors, which can tolerate weakness well and without a substantial increase in muscle stress. In contrast, gait is most sensitive to weakness of plantarflexors, hip abductors, and hip flexors. Weakness of individual muscles results in increased activation of the weak muscle, and in compensatory activation of other muscles. These compensations are generally inefficient, and generate unbalanced joint moments that require compensatory activation in yet other muscles. As a result, total muscle activation increases with weakness as does the cost of walking. By clarifying which muscles are critical to maintaining normal gait, our results provide important insights for developing therapies to prevent or improve gait pathology. © 2012 Elsevier B.V.

Schwartz M.H.,Gillette Childrens Specialty Healthcare | Schwartz M.H.,University of Minnesota | Rozumalski A.,Gillette Childrens Specialty Healthcare | Novacheck T.F.,Gillette Childrens Specialty Healthcare | Novacheck T.F.,University of Minnesota
Gait and Posture | Year: 2014

Excessive femoral anteversion is common among children with cerebral palsy, and is, frequently treated by a femoral derotational osteotomy (FDO). It is important to understand surgical, indications for FDO, and the impact of these indications on the treatment outcomes. The Random Forest algorithm was used to objectively identify historical surgical indications in a large retrospective, cohort of 1088 limbs that had previously undergone single-event multi-level surgery. Treatment, outcome was based on transverse plane kinematics obtained from three-dimensional gait analysis. The, classifier effectively identified the historic indications (accuracy=.85, sensitivity=.93, specificity=.69, positive predictive value=.86, negative predictive value=.82), and naturally divided limbs into four, clusters: two homogeneous +FDO clusters (with/without significant internal hip rotation during gait), one homogeneous -FDO cluster, and a mixed cluster. Concomitant surgeries were similar among the, clusters. Limbs with excessive anteversion and internal hip rotation during gait had excellent outcomes, in the transverse plane. Limbs with excessive anteversion but only mild internal hip rotation had good, outcomes at the hip level; but a significant number of these limbs ended up with an excessive external, foot progression angle. The Random Forest algorithm was highly effective for identifying and, organizing historic surgical indications. The derived criteria can be used to give surgical decision making, guidance in a majority of limbs. The results suggest that limbs with anteversion and significant, internal hip rotation during gait benefit from an FDO, but limbs with excessive anteversion and only, mild internal hip rotation are at risk of developing an excessive external foot progression angle. © 2013 Elsevier B.V.

Tervo R.C.,University of Minnesota | Tervo R.C.,Gillette Childrens Specialty Healthcare
Journal of Child Neurology | Year: 2012

To identify parent-reported symptoms that predict parenting stress in preschoolers with global developmental delay, 201 parents/guardians of 142 boys and 59 girls with global delay, mean age 39.1 months (range, 18 to 63 months) were studied retrospectively. Parents completed the following: (a) a semistructured interview; (b) the Child Development Inventory, (c) Child Behavior Checklist 11/2-5, and the (d) Parenting Stress Index-Short Form. Forty-two percent of parents described clinically significant parenting stress (≥ 85th percentile). The Parenting Stress Index-Short Form subscales Difficult Child and Parent-Child Dysfunctional Interactions were elevated. Parental stress increased with higher gross motor development and decreased as social and fine-motor ratios increased. Furthermore, stress increased when parents reported higher levels on the Emotionally Reactive and Withdrawn scale scores and when parents reported Pervasive Developmental and Oppositional Defiant Problems. In mobile children with global delay, behavior problems predict parenting stress. © The Author(s) 2012.

Skluzacek J.V.,International Dravet Syndrome Epilepsy Action League | Watts K.P.,IDEA League UK | Parsy O.,IDEA League France | Wical B.,Gillette Childrens Specialty Healthcare | Camfield P.,Dalhousie University
Epilepsia | Year: 2011

The advent of social networking via the Internet and the commercial availability of tests for SCN1A mutations permitted the rapid development and growth of parent-led associations that provide advocacy and support, as well as promote education and research regarding Dravet syndrome (DS) in the last 10 years. The International Dravet syndrome Epilepsy Action League (IDEA League) is a partnership of parents and professionals united in the purpose of creating greater awareness and understanding of DS. In 2004, parents in the IDEA League support network began to collect data from families about their children with DS in order to investigate observations that, in addition to epilepsy, many of the children seemed to share similar problems. The information gained suggests comorbid conditions and raises many hypotheses for further research. The process has led to more rigorous formal studies and an increased understanding of the clinical spectrum of DS. There is an urgent need for collaborative research, comprehensive care, and professional and family education. Mortality appears high, primarily due to sudden unexplained death in epilepsy (SUDEP) and status epilepticus (SE). Most parents wish direct discussions with their child's physician about mortality. The high risk of death and the many other stresses related to DS result in recurrent grief and loss for patients and families and highlights their need for additional advocacy and support. © Wiley Periodicals, Inc. 2011 International League Against Epilepsy.

Gillette Childrens Specialty Healthcare | Date: 2013-03-07

A device and method of tapering medication in a post-operative patient is provided. The system includes a stationary base having indicia thereon representative of a defined period of time; a first circular wheel concentrically positioned on the stationary base, the first circular wheel representative of a first medication being taken by a patient; and a pin coupling the substantially circular wheel to said stationary base to permit the wheel to rotate 360 degrees about said base. The method of tapering medication includes gradually increasing the time intervals that medication is administered to a post-operative patient.

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