Nan Hill

Oromotor Dysfunction and Communication Impairments in Children with Cerebral Palsy: A Register Study.

Aimu2002 To report the prevalence, clinical associations, and trends over time of oromotor dysfunction and communication impairments in children with cerebral palsy (CP).

The effect of botulinum toxin A on gastrocnemius length : magnitude and duration of response

Thirty‐nine ambulant children (22 with hemiplegia, 17 with diplegia) with spastic cerebral palsy receiving isolated gastrocnemius muscle injection with botulinum toxin A were studied prospectively. The children had a mean age of 6 years (range 3 to 13 years). Measurement of gastrocnemius muscle length was used to estimate the dynamic component of each childs spasticity and to quantify the response. There was a strong correlation between the dynamic component of spasticity before injection and the corresponding magnitude of the response after injection. Children undergoing repeated injections showed similar correlations. A strong correlation was found between the duration of response and the dynamic component. Children with hemiplegia showed twice the duration for a given dynamic component compared with those with diplegia when injected with the same total dose per unit body weight. Long‐term lengthening did not occur for the cohort, although some patients showed a response at a 12‐month follow‐up. By delaying shortening, the injections may have a role in delaying the need for surgery. Injections were well tolerated with few side effects.

Trends in the prevalence of cerebral palsy in Northern Ireland, 1981–1997

We describe trends in the prevalence of cerebral palsy (CP) by birth weight group, and in the severity of motor impairments and presence of associated intellectual impairment, in Northern Ireland from 1981 to 1997 (n=909; 510 males, 399 females; total population 415 936 live births) using data from a population‐based register of CP. Children with suspected CP or who died before 1 year of age and those with CP of postneonatal origin were excluded. Prevalence of CP was 2.2 per 1000 live births without significant change over time. Among very‐low‐birthweight (<1500g) live births, prevalence was 44.5 per 1000 (95% confidence interval 32.3–59.8) from 1994 to 1997, with evidence of a statistically significant decline in prevalence since the mid‐ to late 1980s accompanied by a decrease in the severity of motor impairment and likelihood of intellectual impairment. Among moderately‐low‐birthweight (1500–2499g) children there was weaker evidence of a peak prevalence in the late 1980s. Prevalence among normal‐birthweight infants did not change significantly, but outcome in terms of severity of motor impairment and intellectual impairment improved in the 1990s. Occurrence of bilateral spasticity from 1994 to 1997 was associated with greater severity and likelihood of intellectual impairment for normal‐birthweight individuals than for low‐ or very‐low‐birth weight individuals.

The changing visual profile of children attending a regional specialist school for the visually impaired in Northern Ireland.

Aim:u2002 To investigate the changing profile of children attending a special school for visually impaired children over a 30‐year period.

A single-unit survey of bowel washout practice in children with neuropathic bowel

An initial washout volume of 500 ml was prescribed for all children and, in some cases this was titrated according to effect. Salt was added to tap-water to approximate an isotonic solution for all washouts. In the washout solution twelve children required a laxative (sodium citrate in 11, and bisacodyl in one), while four did not. Rectal washouts were all administered via a balloon-catheter (Coloplasts Peristeen system in 7 children), and most ACE washouts via a gastrostomy button-device (7 children).

Palliative care: recognition of changing need in a children's spina bifida service in Northern Ireland

Background The regional Spina Bifida (SB) service for Northern Ireland is organised through two multi-professional teams based in Belfast, one for children and the other for those of older teenage years and beyond who transfer to an adult service. Although the incidence of SB is lower in comparison to earlier decades, more children are living longer with complex problems requiring support and remediation. This study examines the palliative care needs of children and young people with SB attending the childrens service that were recognised as having a life-limiting dimension; required symptom control; and there was an expectation of early death.

Upper limb function in children with spina bifida

Materials and Methods The sample patients were identified from the patients born with spina bifida in the ten year period 1987–96, ensuring that the children would be at least 6 years old. The skin and sensory levels of the lesion were documented as well as the history of hydrocephalus and shunt revision. Upper limb function was determined using measures of coarse (putting pellets in a cup and pegs in a pegboard) and fine (repetitive finger movements, repeated pronation and supination and 20 Claps) movements.