Kent Campbell

Secondary Health Complications in an Aging Canadian Spinal Cord Injury Sample

Hitzig SL, Tonack M, Campbell KA, McGillivray CF, Boschen KA, Richards K, Craven BC: Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Med Rehabil 2008;87:545–555. Objectives:This study describes self-reported incidence of secondary health complications (SHCs) and their associations with age, years postinjury (YPI), and impairment among a Canadian spinal cord-injured (SCI) cohort. Design:Cross-sectional telephone survey methods were used to collect data on (1) sociodemographics, (2) impairment, (3) health status, and (4) self-reported SHCs on 781 adults ≥1 yr post-SCI living in Ontario, Canada. Results:Logistic regression analyses were used to determine associations between self-reported incidences of SHCs with the following covariates: (1) age, (2) YPI, and (3) impairment. The odds ratios for cardiac complications, high blood pressure (HBP), and respiratory complications increased per year with age, whereas autonomic dysreflexia (AD), bladder infections, heterotopic ossification, psychological distress, and drug addiction decreased. The odds ratios for pressure ulcers, AD, and heterotopic ossification increased per YPI, whereas HBP, bowel problems, psychological distress, and depression decreased. Complete injuries were associated with bladder infections, pressure ulcers, and AD. Paraplegia was associated with HBP and bowel problems, and tetraplegia was associated with AD. Conclusions:The findings provide some clarification on factors associated with the occurrence of SHCs after SCI and are useful for informing health-promotion planners, clinicians, and stakeholders regarding the odds of SHCs with aging or among specific impairment groups.

Development of a scale to measure the psychosocial impact of assistive devices: lessons learned and the road ahead

Purpose : In this paper the history of the development and validation of the PIADS is reviewed. Assistive devices (ADs) are extremely prevalent forms of health care intervention for persons who have a disability. There is a consensus that the AD field needs a reliable and valid measure of how users perceive the impact of ADs on their quality of life (QoL) and sense of well-being. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26 item self-rating scale designed to fill this measurement gap. The challenges that we encountered are described in attempting to adequately conceptualize QOL impact, and operationalize it in a measure suitable for use with virtually all forms of AD. Current efforts to extend the validation of the PIADS are summarized. Conclusions : The study concludes by suggesting directions for future research and development of the scale. They include a richer examination of its conceptual relationships to other health care and rehabilitation outcome measures, and further investigation of its clinical utility. The PIADS is a reliable and valid tool that appears to have very significant power to predict AD abandonment and retention. It can and should be used both deductively and inductively to build, discover and test theory about the psychosocial impact of assistive technology.

A Randomized Controlled Trial Comparing Botulinum Toxin A Dosage in the Upper Extremity of Children with Spasticity.

This study compared the effects of low and high doses of botulinum toxin A (BTX‐A) to improve upper extremity function. Thirty‐nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double‐blind, randomized controlled trial. The high‐dose group received BTX‐A in the following doses: biceps 2U/kg, brachioradialis 1.5U/kg, common flexor origin 3U/kg, pronator teres 1.5U/kg, and adductor/opponens pollicis 0.6U/kg to a maximum of 20U. The low‐dose group received 50% of this dosage. Outcomes were measured at baseline and at 1 and 3 months after injection, and results were analyzed with a repeated‐measures analysis of variance. There was no significant difference between the low‐dose and high‐dose groups in upper extremity function over the 3‐month period as measured by the Quality of Upper Extremity Skills Test (F[1,37]=0.18, p=0.68). There was no difference between the groups in the Pediatric Evaluation of Disability Inventory Self Care Domain (F[1,37]=0.05, p=0.83). Although grip strength decreased over the 3‐month period, there was no difference between groups (F[1,32]=0.45, p=0.51). These findings indicate that there is no difference in hand and arm function between a low dose and a high dose of BTX‐A at 1 and 3 months after injection. This information can be used to guide dosage of BTX‐A for the management of upper extremity spasticity in children.

The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families

OBJECTIVE To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families. DESIGN Baseline-intervention-baseline study. SETTING Homes of participating families. PARTICIPANTS Thirty parents and their children with Gross Motor Function Classification System level III or IV CP. INTERVENTIONS Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet. MAIN OUTCOME MEASURES Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS). RESULTS Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F(1.4,40.6)=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores. CONCLUSIONS The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families.

Effect of adaptive seating devices on the activity performance of children with cerebral palsy.

OBJECTIVE To evaluate the short-term impact of 2 adaptive seating devices on the activity performance and satisfaction with performance of children with cerebral palsy (CP), as observed by their parents. DESIGN Baseline-intervention-baseline study. SETTING Homes of participating families. PARTICIPANTS Parents and their children (N=30), mean age of 4 years 6 months, with Gross Motor Function Classification System levels III and IV CP participated. INTERVENTIONS Two special purpose seating devices: one for sitting support on the floor or on a chair, the other for postural control on a toilet. MAIN OUTCOME MEASURES Changes in activity performance and satisfaction were measured through parent ratings on the Canadian Occupational Performance Measure. We interviewed parents biweekly using the Home Activity Log to describe and explain their childs activity performance during the 3 study phases. RESULTS Parents identified 139 activity performance issues (4.6 a child): 58.3% in self-care, 34.5% in play, and 7.2% in socialization and quiet recreation. We used paired t tests to demonstrate significantly improved performance and satisfaction with self-care and play activities when the children used the adaptive seating devices during the 6-week intervention phase. Three themes arose from the analysis of comments made by parents during Home Activity Log interviews: adaptive seating can have an enabling influence on the child, caregivers and family find adaptive seating useful, and the adaptive seating devices did not meet every familys needs. CONCLUSIONS Parents reported that their young children with CP were more able to engage in self-care and play activities when using specific adaptive seating devices in their home. Parents indicated that their childs activity performance decreased after the seating devices were removed from their homes.

Electronic aids to daily living and quality of life for persons with tetraplegia

Purpose. To compare the satisfaction with quality of life (QOL) of adults with tetraplegia from spinal cord injury (SCI) who use and do not use electronic aids to daily living (EADLs). Method. This study used a cross-sectional design. Thirty-six persons with spinal cord injuries or conditions at or above C5/6 level participated. Fifteen participants used EADL at home and 21 formed the comparison group of non-users of EADL; all were living in the community. We used the Quality of Life Profile-Physical Disabilities (QOLP-PD) to examine participants QOL. Results. Both groups rated the levels of importance of all aspects of QOL equally. The EADL users rated their satisfaction with QOL significantly higher for total QOLP-PD scores and for four of the nine domains, including all three domains of belonging. The groups did not differ in age, FIM scores, level of education, and hours of paid attendant care. The EADL user group had significantly more males than females, and had higher levels of SCI. Conclusions. EADLs appear to contribute to the experience of greater subjective QOL for persons with severe physical disability from high SCI. Prospective cohort studies designs that employ methods and analytic plans to study the causal effect of EADLs on QOL are recommended. The QOLP-PD was found to be a valid measure of QOL for this population.

Evaluation of therapeutic electrical stimulation to improve muscle strength and function in children with types II/III spinal muscular atrophy

The study aimed to evaluate the effect of low‐intensity nighttime therapeutic electrical stimulation (TES) on arm strength and function in children with intermediate type spinal muscular atrophy (SMA). The design was a randomized controlled trial with a 6‐month baseline control period. Children were evaluated at baseline, 6, and 12 months. TES was applied from 6 to 12 months to the deltoid and biceps muscle, of a randomly selected arm with the opposite arm receiving a placebo stimulator. Thirteen individuals with SMA between 5 to 19 years of age were recruited into the study and eight completed the 12‐month assessment. No statistically significant differences between the treatment and control arm were found at baseline, 6, and 12 months for elbow flexors, or shoulder abductors on quantitative myometry or manual muscle testing. There was no significant change in excitable muscle mass assessed by M‐wave amplitudes, nor function on the Pediatric Evaluation of Disability Inventory (self‐care domain). Therefore, in this study there was no evidence that TES improved strength in children with SMA.

Functional Outcomes Associated With Adaptive Seating Interventions in Children and Youth With Wheeled Mobility Needs

OBJECTIVE To determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DESIGN Longitudinal case series. SETTING Homes of participating parents. PARTICIPANTS Parents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. INTERVENTION Adaptive seating system for wheeled mobility devices. MAIN OUTCOME MEASURE Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). RESULTS All parents completed the FIATS-AS 4 times-2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η(2)=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. CONCLUSIONS Adaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

Evaluation of a parent-report diary of the home use of assistive devices by young children with cerebral palsy

Purpose. To develop and evaluate the preliminary measurement properties of a parent-report diary of the home use of seating and mobility devices by young children with cerebral palsy (CP). Method. Four AT experts reviewed the home use of technology for children (HUTCH) diary to confirm its coverage of AT devices, and six parents of young children with CP examined its content, wording and organization. A random sample of 12 other parents independently completed a HUTCH diary daily for 1 week to record their childs use of seating, mobility and orthotic devices at home. Two to three weeks later, parents completed a second diary of AT device use over another seven consecutive days. Results. The face validity, content validity and test–retest reliability (ICC = 0.91; 95% CI = 0.69–0.97) of the HUTCH were very good. Parents reported that they completed the diary quickly and easily. Conclusions. The HUTCH diary shows promise as a reliable and practical way to record the frequency and number of hours that children use different types of seating and mobility-related devices at home. Testing the concurrent validity of the HUTCH diary against an acceptable criterion measure will improve its acceptance as measure of AT device use.

Is telephone assessment a valid tool in rehabilitation research and practice

Purpose: To determine if face-to-face and telephone administration of questionnaires produce comparable results in rehabilitation research studies. Method: A total of 80 participants who used eyeglasses as their primary visual assistive device agreed to participate. All completed the Life Orientation Test and the Psychosocial Impact of Assistive Devices Scale. Approximately half of the participants completed the forms after being approached by an interviewer and then were contacted by telephone 2 weeks later to complete the forms a second time. The other half of the participants initially completed the forms over the telephone and then met with an interviewer 2 weeks later and completed the forms face-to-face. Results: For the forms used no statistically significant differences were found between groups or over time. Conclusion: For some questionnaires telephone administration may provide a convenient and cost-effective method of data collection. However, it should not be automatically assumed that all questionnaires will yield the same results regardless of the mode of administration used.