Heleen A. Reinders-Messelink

Evaluation of the Developmental Coordination Disorder Questionnaire as a screening instrument

Reliability and validity of the Developmental Coordination Disorder Questionnaire (DCD-Q) was assessed using a population-based sample of 608 children (311 males, 297 females; mean age 7 y 8 mo [SD 2 y 4 mo]), a sample of 55 children with DCD referred to a rehabilitation clinic, and a control sample of 55 children matched for age and sex (48 males, seven females in each sample; mean age 8 y 3 mo [SD 2 y]). The DCD-Q is reliable and valid in the age range for which the questionnaire was developed(8 y-14 y 7 mo) and in a younger age range (4-8 y). Sensitivity and specificity of the DCD-Q was assessed using the Movement Assessment Battery for Children as the criterion standard. The DCD-Q met the standard for sensitivity (80%) in the clinic-referred sample (81.6%), but not in the population-based sample (28.9%). Specificity almost reached the standard of 90%: 89% in the population-based sample and 84% in the clinic-referred sample.

The i-LIMB hand and the DMC plus hand compared: A case report

The i-LIMB hand is a novel upper limb myoelectric prosthetic hand with several joints in the fingers and thumb. This study aimed to determine whether this new device had more functionality than a more conventional myoelectric prosthetic hand with only a single joint between the thumb and two fingers. Therefore, a 45-year-old man with a wrist disarticulation used the i-LIMB hand and the widely used Dynamic Mode Control hand (DMC plus hand) in a test procedure that covered all functional levels of the International Classification of Function (ICF). Functional outcomes of the i-LIMB seemed to be lower than or equal to the DMC plus hand. The patients satisfaction tended to be in favor of the i-LIMB. Compared to the DMC plus hand, the i-LIMB was more reliable when holding objects but had a lack of power and was less robust. We concluded that the i-LIMB hand has limited additional functionality compared to the DMC plus hand.

Music in the treatment of neurological language and speech disorders: A systematic review

Background: Acquired brain injury resulting from a stroke can result in impairments in, among other things, communication. Music therapy has been used in rehabilitation to stimulate brain functions involved in speech. The use of elements of music is well known and more often used in the treatment of aphasia and apraxia of speech. Aims: The aim of the study is to synthesise studies on the effect of music parameters in the treatment of neurological language and speech disorders. In addition, possible mechanisms that explain recovery are investigated. Methods & Procedures: Search terms were formulated based on the research question. A systematic search in databases was performed using these search terms. Then inclusion criteria were formulated and articles meeting the criteria were reviewed on patient characteristics, interventions, and methodological quality. Outcomes & Results: A total of 1250 articles have been selected from the databases, of which 15 were included in this study. The Melodic Intonation Therapy was the most studied programme. Melody and rhythm were the music interventions that have been applied the most. Measurable recovery has been reported in all those reviewed studies using music in the treatment of neurological language and speech disorders. In three studies research was also conducted into the mechanisms of explanation of the measured recovery. However, the methodological quality of the investigated studies was rated as “low”, using the ASHA level of evidence indicators for judging research. Conclusions: Although treatment outcomes were reported as positive in all of the 15 reviewed studies, caution should be used relative to conclusions about the effectiveness of treatments that incorporate components of music with neurologically impaired individuals. Methodological quality was rated as low and interpretations of mechanisms of recovery were contradictory. Suggestions for standardising and improving methodological quality drawn from the analysis are presented. A revised version of this article has been published in a Dutch journal (Stem Spraak- en Taalpathologie).

LEARN 2 MOVE 7-12 years: a randomized controlled trial on the effects of a physical activity stimulation program in children with cerebral palsy

BackgroundRegular participation in physical activities is important for all children to stay fit and healthy. Children with cerebral palsy have reduced levels of physical activity, compared to typically developing children. The aim of the LEARN 2 MOVE 7-12 study is to improve physical activity by means of a physical activity stimulation program, consisting of a lifestyle intervention and a fitness training program.Methods/DesignThis study will be a 6-month single-blinded randomized controlled trial with a 6-month follow up. Fifty children with spastic cerebral palsy, aged 7 to 12 years, with Gross Motor Function Classification System levels I-III, will be recruited in pediatric physiotherapy practices and special schools for children with disabilities. The children will be randomly assigned to either the intervention group or control group. The children in the control group will continue with their regular pediatric physiotherapy, and the children in the intervention group will participate in a 6-month physical activity stimulation program. The physical activity stimulation program consists of a 6-month lifestyle intervention, in combination with a 4-month fitness training program. The lifestyle intervention includes counseling the child and the parents to adopt an active lifestyle through Motivational Interviewing, and home-based physiotherapy to practise mobility-related activities in the daily situation. Data will be collected just before the start of the intervention (T0), after the 4-month fitness training program (T4), after the 6-month lifestyle intervention (T6), and after six months of follow-up (T12). Primary outcomes are physical activity, measured with the StepWatch Activity Monitor and with self-reports. Secondary outcomes are fitness, capacity of mobility, social participation and health-related quality of life. A random coefficient analysis will be performed to determine differences in treatment effect between the control group and the intervention group, with primary outcomes and secondary outcomes as the dependent variables.DiscussionThis is the first study that investigates the effect of a combined lifestyle intervention and fitness training on physical activity. Temporary effects of the fitness training are expected to be maintained by changes to an active lifestyle in daily life and in the home situation.Trial registrationThis study is registered in the Dutch Trial Register as NTR2099.

LEARN 2 MOVE 0-2 years: effects of a new intervention program in infants at very high risk for cerebral palsy; a randomized controlled trial.

BackgroundIt is widely accepted that infants at risk for cerebral palsy need paediatric physiotherapy. However, there is little evidence for the efficacy of physiotherapeutic intervention. Recently, a new intervention program, COPCA (Coping with and Caring for infants with special needs - a family centered program), was developed. COPCA has educational and motor goals. A previous study indicated that the COPCA-approach is associated with better developmental outcomes for infants at high risk for developmental disorders. LEARN 2 MOVE 0-2 years evaluates the efficacy and the working mechanisms of the COPCA program in infants at very high risk for cerebral palsy in comparison to the efficacy of traditional infant physiotherapy in a randomized controlled trial. The objective is to evaluate the effects of both intervention programs on motor, cognitive and daily functioning of the child and the family and to get insight in the working elements of early intervention methods.Methods/designInfants are included at the corrected age of 1 to 9 months and randomized into a group receiving COPCA and a group receiving traditional infant physiotherapy. Both interventions are given once a week during one year. Measurements are performed at baseline, during and after the intervention period and at the corrected age of 21 months. Primary outcome of the study is the Infant Motor Profile, a qualitative evaluation instrument of motor behaviour in infancy. Secondary measurements focus on activities and participation, body functions and structures, family functioning, quality of life and working mechanisms. To cope with the heterogeneity in physiotherapy, physiotherapeutic sessions are video-recorded three times (baseline, after 6 months and at the end of the intervention period). Physiotherapeutic actions will be quantified and related to outcome.DiscussionLEARN 2 MOVE 0-2 years evaluates and explores the effects of COPCA and TIP. Whatever the outcome of the project, it will improve our understanding of early intervention in children with cerebral palsy. Such knowledge is a prerequisite for tailor-made guidance of children with CP and their families.Trial registrationThe trial is registered under NTR1428.

Transparency and tuning of rehabilitation care for children with cerebral palsy: A multiple case study in five children with complex needs

Purpose: Generally, there is a lack of knowledge whether and how parent-identified problems, treatment goals and treatment activities are tuned in the treatment of children with cerebral palsy. This study aimed to observe whether parent-identified problems and treatment goals were documented (‘transparency’ of the rehabilitation process), and to examine the relationship (‘tuning’) of parent-identified problems to treatment goals and to treatment activities of children with cerebral palsy in pediatric rehabilitation in the Netherlands. Method: Five school-aged subjects with cerebral palsy were observed in detail during physical, occupational, and speech therapy, and their written reports were studied. Parent-identified problems, treatment goals, and treatment activities were linked to the ICF components, domains and categories and the amount of agreement was determined by code comparison. Results: Only two children with a total of six parent-identified problems could be documented. Forty-five treatment goals were identified and 72 treatment activities were observed. The analyses indicated some tuning of parent-identified problems, goals and activities in all subjects, but only four of the treatment activities were perfectly tuned to treatment goals as well as to parent-identified problems. Conclusions: We conclude that transparency and tuning of the pediatric treatment process described in the present study could be improved substantially. Several suggestions for improving the transparency and tuning of the treatment process are discussed.

A review of salient elements defining team collaboration in paediatric rehabilitation

Objective: To explicate the complex process of team collaboration and identify salient elements of team collaboration in paediatric rehabilitation. Data sources: After an initial search to define key features of team collaboration a systematic search on team collaboration and the key features was executed to identify salient elements. The systematic search was carried out in Index Medicus (MEDLINE), Educational Resource Information Clearinghouse (ERIC) and American Psychological Association (Psyc INFO) covering the period from January 1993 to December 2004. Review methods: Based on title and abstract relevant publications were identified and qualitatively assessed by two reviewers. To facilitate the interpretation of the salient elements, the articles were also classified according to the criteria ‘participants and setting’ and ‘research method’. Results: Of the total of 930 identified publications 28 studies proved eligible and were subsequently assessed. The evaluation yielded 29 salient elements defining five key features of team collaboration (i.e. communication, decision making, goal setting, organization and team process). Parent involvement proved to play a dominant role and was mentioned in relation to all five features. Conclusions: Based on the results, rather than an underlying element, it is proposed to consider parent involvement as the sixth feature of team collaboration. The 29 distinctive elements of teamwork could be useful as a guideline and checklist for empirical studies and may help enhance multidisciplinary collaboration in paediatric care. However, additional exploratory research focusing on the way these elements interact with each other and the key features and whether they facilitate or restrict team collaboration is warranted.

Developmental Trajectories of Daily Activities in Children and Adolescents With Cerebral Palsy

OBJECTIVES: To describe the developmental trajectories of mobility performance and daily activities in children and young adults with cerebral palsy (CP). To explore the influence of gross motor function and intellectual disability on these trajectories. METHODS: Four hundred and twenty-four Dutch participants with CP (aged 1–20 years at study onset) were followed yearly over a period of 2 to 4 years. Developmental trajectories (from ages 1–16 years) were described for mobility performance and performance of daily activities, assessed by using the Vineland Adaptive Behavior Scale for gross motor function (classified by the Gross Motor Function Classification System) and intellectual disability (by IQ or school type). A subanalysis was done for performance of daily activities in a subgroup of participants without intellectual disability (aged 1–24 years). RESULTS: The developmental trajectories of mobility performance differed according to levels of gross motor function but not levels of intellectual disability. Intellectual disability affected the performance of daily activities, with lower overall trajectory levels for participants with intellectual disabilities. For participants without intellectual disability, high-level developmental trajectories were found, with values similar to those of typically developing children despite differences in gross motor function level. CONCLUSIONS: Mobility performance is determined mainly by levels of gross motor function. For performance of daily activities, intellectual disability was a more important determinant. Participants without intellectual disability showed developmental trajectories approaching values for typically developing participants. These estimated trajectories can guide rehabilitation interventions and future expectations for children and young adults with CP.

LEARN 2 MOVE 2-3: a randomized controlled trial on the efficacy of child-focused intervention and context-focused intervention in preschool children with cerebral palsy

BackgroundLittle is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP). In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years) with CP and their families: a child-focused intervention approach and a context-focused intervention approach.Methods/DesignA multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS) level I-IV; age 2 to 3 years), their parents, and service providers (physical and occupational therapists) will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI). Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY), including body function and structure, activities (gross motor capacity and performance of daily activities), social participation, environmental variables (family functioning, parental empowerment).DiscussionThis paper presents the background information, design, description of interventions and protocol for this study on the efficacy and working mechanisms of child-focused intervention approach and context-focused intervention approach compared to regular care intervention in mobility and self-care skills of children (2-3 years) with CP.Trial registrationThis study is registered in the Dutch Trial Register as NTR1900

Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries.

PURPOSE Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of acute PTSD in hand-injured patients. METHODS Sixty-seven employed patients with hand injuries completed a number of questionnaires. The following factors were investigated: sociodemographic characteristics, injury severity, accident location, pain, satisfaction with hand functioning, aesthetics of the hand, social support, and coping styles. The primary outcome measure was the number of symptoms of PTSD. We analyzed factors that were univariately significantly associated with symptoms of PTSD using linear regression analysis, and explored interaction effects. RESULTS One patient met the criteria for PTSD; 44 patients experienced symptoms but did not meet the criteria (median, 1; interquartile range (IQR), 0-2); 22 patients experienced no symptoms of PTSD. Patients had a median pain score of 30 (IQR, 10-45), median satisfaction score of 60 (IQR, 45-70), median aesthetics score of 66.7 (IQR, 45.8-79.2), median palliative coping style score of 16 (IQR, 14.8-17.3), and median avoidance coping style of 15 (IQR, 13-16). Symptoms of PTSD were associated with pain (r, .530; p < .001), satisfaction with hand function (r, -.451; p < .001), aesthetics (r, -.320; p = .009), palliative coping style (r, .281; p = .022) and avoidance coping style (r, .283; p = .022). Pain and aesthetics remained significant after regression analysis. No interaction effects were significant. CONCLUSIONS Pain and aesthetics statistically predict symptoms of acute PTSD in patients with acute hand injuries. Patients with disproportionate pain or dissatisfaction with aesthetics should be evaluated for PTSD. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.