Constraint-Induced Movement therapy (CIMT/ CIT) or CI therapy is a new therapeutic approach to rehabilitation of hand and arm movement after stroke, cerebral palsy, brachial plexus injury, multiple sclerosis (MS) and traumatic brain injury (TBI). CI therapy consists of a family of treatments that teach the brain to “rewire” itself following a neurological injury. CI therapy is based on research by Prof. Edward Taub and his collaborators at the University of Alabama at Birmingham, USA that showed that patients can learn to improve movement of the weaker part of their bodies.CIMT is a 2-3 week treatment program that includes restraint of the non-affected hand for most of the waking hours and intensive practice of the affected one for specific hours per day. Practice is focused on everyday activities that are important for the patient and takes place in the clinic and at home. The daily home-based program is tailor made to match each person’s abilities and interests.
Posts Tagged Children
[BLOG POST] Anti-epilepsy medicine use during pregnancy does not harm overall health of children, study finds
Children whose mothers have taken anti-epilepsy medicine during pregnancy, do not visit the doctor more often than children who have not been exposed to this medicine in utero. This is the result of a new study from Aarhus.
Previous studies have shown that anti-epilepsy medicine may lead to congenital malformations in the foetus and that the use of anti-epilepsy medicine during pregnancy affects the development of the brain among the children. There is still a lack of knowledge in the area about the general health of children who are exposed to anti-epilepsy medicine in foetallife. But this new study is generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy.
Being born to a mother who has taken anti-epilepsy medicine during pregnancy appears not to harm the child’s health. These are the findings of the first Danish study of the correlation between anti-epilepsy medicine and the general health of the child which has been carried out by the Research Unit for General Practice, Aarhus University and Aarhus University Hospital.
The results have just been published in the international scientific journal BMJ Open.
The researchers have looked into whether children who have been exposed to the mother’s anti-epilepsy medicine have contact with their general practitioner (GP) more often than other children – and there are no significant differences.
No reason til worry
“Our results are generally reassuring for women who need to take anti-epilepsy medicine during their pregnancy, including women with epilepsy,” says Anne Mette Lund Würtz, who is one of the researchers behind the project.
The difference in the number of contacts to the general practitioner between exposed and non-exposed children is only three per cent.
“The small difference we found in the number of contacts is primarily due to a difference in the number of telephone contacts and not to actual visits to the GP. At the same time, we cannot rule out that the difference in the number of contacts is caused by a small group of children who have more frequent contact with their GP because of illness,” explains Anne Mette Lund Würtz.
Of the 963,010 children born between 1997 and 2012, who were included in the survey, anti-epilepsy medicine was used in 4,478 of the pregnancies that were studied.
Anti-epilepsy medicine is also used for the treatment of other diseases such as migraine and bipolar disorder. The study shows that there were no differences relating to whether the women who used anti-epilepsy medicine during pregnancy were diagnosed with epilepsy or not.
Background for the results
Type of study: The population study was carried out using the Danish registers for the period 1997-2013.
The analyses takes into account differences in the child’s gender and date of birth, as well as the mother’s age, family situation, income, level of education, as well as any mental illness, use of psychiatric medicine and insulin, and substance abuse.
People with epilepsy resort to cannabis products when antiepileptic drug side-effects are intolerable and epilepsy uncontrolled.
The first Australian nationwide survey on the experiences and opinions of medicinal cannabis use in people with epilepsy has revealed that 14 per cent of people with epilepsy have used cannabis products as a way to manage seizures.
The study showed that of those with a history of cannabis product use, 90 per cent of adults and 71 per cent of parents of children with epilepsy reported success in managing seizures after commencing using cannabis products.
Published in Epilepsy & Behaviour, the Epilepsy Action Australia study, in partnership with The Lambert Initiative at the University of Sydney, surveyed 976 respondents to examine cannabis use in people with epilepsy, reasons for use, and any perceived benefits self-reported by consumers (or their carers).
The survey revealed:
- 15 per cent of adults with epilepsy and 13 per cent of parents/guardians of children with epilepsy were currently using, or had previously used, cannabis products to treat epilepsy.
- Across all respondents, the main reasons for trying cannabis products were to manage treatment-resistant epilepsy and to obtain a more favourable side-effect profile compared to standard antiepileptic drugs.
The number of past antiepileptic drugs was a significant predictor of medicinal cannabis use in both adults and children with epilepsy.
“This survey provides insight into the use of cannabis products for epilepsy, in particular some of the likely factors influencing use, as well as novel insights into the experiences of and attitudes towards medicinal cannabis in people with epilepsy in the Australian community,” said lead author Anastasia Suraev from The Lambert Initiative.
“Despite the limitations of a retrospective online survey, we cannot ignore that a significant proportion of adults and children with epilepsy are using cannabis-based products in Australia, and many are self-reporting considerable benefits to their condition.
“More systematic clinical studies are urgently needed to help us better understand the role of cannabinoids in epilepsy,” she said.
Co-author of the paper Carol Ireland, CEO of Epilepsy Action Australia, who was recently appointed to the Australian Government’s new Australian Advisory Council on the Medicinal Use of Cannabis, said: “Cannabis products are often what people turn to when they have been unable to control their epilepsy with conventional medication.”
“This highlights a growing need to educate consumers and health professionals on the use of cannabis by people with epilepsy, and to provide safe and timely access to cannabinoid medicine in order to lessen people’s reliance on illicit black market products” she said.
[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text
Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.
Doctors are beginning to get answers to the question that every parent whose child has had a traumatic brain injury (TBI) wants to know: What will my child be like 10 years from now?
In a study to be presented Friday Feb. 10 at the annual meeting of the Association of Academic Physiatrists in Las Vegas, researchers from Cincinnati Children’s will present research on long-term effects of TBI—an average of seven years after injury. Patients with mild to moderate brain injuries are two times more likely to have developed attention problems, and those with severe injuries are five times more likely to develop secondary ADHD. These researchers are also finding that the family environment influences the development of these attention problems.
- Parenting and the home environment exert a powerful influence on recovery. Children with severe TBI in optimal environments may show few effects of their injuries while children with milder injuries from disadvantaged or chaotic homes often demonstrate persistent problems.
- Early family response may be particularly important for long-term outcomes suggesting that working to promote effective parenting may be an important early intervention.
- Certain skills that can affect social functioning, such as speed of information processing, inhibition, and reasoning, show greater long-term effects.
- Many children do very well long-term after brain injury and most do not have across the board deficits.
More than 630,000 children and teenagers in the United States are treated in emergency rooms for TBI each year. But predictors of recovery following TBI, particularly the roles of genes and environment, are unclear. These environmental factors include family functioning, parenting practices, home environment, and socioeconomic status. Researchers at Cincinnati Children’s are working to identify genes important to recovery after TBI and understand how these genes may interact with environmental factors to influence recovery.
- They will be collecting salivary DNA samples from more than 330 children participating in the Approaches and Decisions in Acute Pediatric TBI Trial.
- he primary outcome will be global functioning at 3, 6, and 12 months post injury, and secondary outcomes will include a comprehensive assessment of cognitive and behavioral functioning at 12 months post injury.
- This project will provide information to inform individualized prognosis and treatment plans.
Using neuroimaging and other technologies, scientists are also learning more about brain structure and connectivity related to persistent symptoms after TBI. In a not-yet-published Cincinnati Children’s study, for example, researchers investigated the structural connectivity of brain networks following aerobic training. The recovery of structural connectivity they discovered suggests that aerobic training may lead to improvement in symptoms.
Over the past two decades, investigators at Cincinnati Children’s have conducted a series of studies to develop and test interventions to improve cognitive and behavioral outcomes following pediatric brain injury. They developed an innovative web-based program that provides family-centered training in problem-solving, communication, and self-regulation.
- Across a series of randomized trials, online family problem-solving treatment has been shown to reduce behavior problems and executive dysfunction (management of cognitive processes) in older children with TBI, and over the longer-term improved everyday functioning in 12-17 year olds.
- Web-based parenting skills programs targeting younger children have resulted in improved parent-child interactions and reduced behavior problems. In a computerized pilot trial of attention and memory, children had improvements in sustained attention and parent-reported executive function behaviors. These intervention studies suggest several avenues for working to improve short- and long-term recovery following TBI.
Use it or lose it
- WHAT IS CIMT?
Monday, August 1, 2016
“Parents should be aware of the increased risk of [other] problems for their children,” said study author Dr. Richard Chin.
Epilepsy is a chronic seizure disorder. It is estimated that nearly 4 million people in the United States have epilepsy, according to the U.S. Centers for Disease Control and Prevention.
The new study included health information on more than a million Norwegian children from 2008 through 2013. About 6,600 of the children had a diagnosis of epilepsy, the researchers said.
The data showed that nearly four out of five children with epilepsy had at least one other health issue. These included medical, neurological, developmental or psychiatric problems.
Just 30 percent of the children without epilepsy had additional health issues, the study authors found.
Children already diagnosed with “complicated” epilepsy had the highest overall levels of other health issues, but even the children with less complicated epilepsy were at risk compared to the general population. Complicated epilepsy is epilepsy that occurs with other disorders, and those disorders may share the same causes or risk factors with epilepsy, or in some cases they may even be the cause of the epilepsy, the study authors said.
While experts have long been aware of the risk for other health issues in epilepsy patients, Chin said the researchers “were surprised that it was as high as 80 percent.”
Chin is a senior clinical research fellow in pediatric neurosciences and director of the Muir Maxwell Epilepsy Centre, University of Edinburgh and the Royal Hospital for Sick Children Edinburgh in Scotland.
One strength of the new research is the size of the population studied and the wide range of issues the investigators looked at, the study authors said.
After digestive problems, other common medical problems included birth defects not involving the central nervous system, musculoskeletal problems, asthma and other respiratory issues.
Among the common neurological disorders were cerebral palsy, headache and neurologic birth defects (such as spina bifida). Attention-deficit/hyperactivity disorder (ADHD) was more than five times as common in children with epilepsy as in those without, affecting 12 percent of the children with the seizure disorder, the findings showed.
Chin said the study findings are in line with a new view of epilepsy that has been suggested by some experts. “New definition proposals have sought to frame epilepsy as not just a seizure disorder, but as a disorder with a wide range of neurobiological, cognitive, psychological and social aspects,” he said.
Whether the other health issues may decline with age isn’t certain, Chin said.
While the 80 percent figure seems high, “it’s believable,” said Dr. Ian Miller, pediatric neurologist and medical director of the comprehensive epilepsy program at Nicklaus Children’s Hospital in Miami. He reviewed the research.
As for why children with epilepsy may be so prone to other health problems, Miller said he can speculate about several possibilities. Besides Chin’s view that epilepsy is not just a seizure disorder, Miller explained that “kids with epilepsy take medications, which can cause side effects, which then [might] create a second problem.”
Seizures can cause injuries such as falls and fractures, and those can create additional problems, Miller noted.
For now, Chin said, the best advice for parents is to be sure their child is thoroughly assessed for all aspects of their health. Those aspects include their development, psychiatric health, nutrition, growth and sleep quality.
Miller added: “Make sure you discuss any new symptoms with your child’s neurologist and/or pediatrician. Just because you have one medical problem, it won’t protect you from having a second.”
SOURCES: Richard Chin, M.D., Ph.D., senior clinical research fellow, pediatric neurosciences and director, Muir Maxwell Epilepsy Centre, University of Edinburgh and Royal Hospital for Sick Children Edinburgh; Ian Miller, M.D., pediatric neurologist and medical director, comprehensive epilepsy program, Nicklaus Children’s Hospital, Miami; Aug. 1, 2016, Pediatrics, online
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[WEB SITE] Brain Surgery through One-Inch Opening Successfully Treats Epileptic Seizures in Children
Detroit Medical Center Children’s Hospital of Michigan Pediatric Neurosurgeon Sandeep Sood, M.D., developed minimally-invasive endoscopic surgery, demonstrated efficacy in treating intractable epileptic seizures in children.
After eight years of study, a Children’s Hospital of Michigan neurosurgeon and his colleagues are using an endoscope to perform surgical procedures to help control intractable epileptic seizures in pediatric patients – without subjecting them to the invasive skull surgery that has been previously required for treatment.
The pioneering surgical technique by Sandeep Sood, M.D., who is also an associate professor of Neurosurgery at the Wayne State University School of Medicine, will be featured on the cover of the December 2015 issue of the Journal of Neurosurgery Pediatrics. The minimally-invasive surgical breakthrough could become the standard of care for stopping seizures in patients considered candidates for corpus callosotomy, the structure of nerve fibers that allows for communication between the two sides of the brain, and hemispherotomy. The treatment will reduce or eliminate the need for large skull incisions and accompanying risks, including pain, infection, need for blood transfusions and lengthy hospital stays.
“Our method of attaching an instrument to the endoscope is a paradigm shift in minimally invasive brain surgery. Recent addition of 3D endoscope to this technique has provided better lighting, greater magnification and adds precision to the tissue disconnection procedures,”Dr. Sood explained at an International Society for Pediatric Neurosurgery meeting last month in Turkey. “As one of the premier Comprehensive Epilepsy Surgery Center in the nation, we have extensive experience treating children with intractable seizures. It seemed only reasonable to adapt the endoscopic surgical techniques which we have effectively used in removing brain tumors to epilepsy surgery. We can now safely perform these operations with an incision just about an inch long.”
The story in the Journal of Neurosurgery Pediatrics, published online, (Endoscopic corpus callosotomy and hemispherotomy, http://thejns.org/doi/abs/10.3171/2015.5.PEDS1531 ), concluded that “endoscopic disconnective procedures are an attractive option to an open operation.”
The study also noted that “the major disadvantages of open [brain-surgery procedures] include increased blood loss, post-operative pain and a longer hospital stay…. We have recently refined our bimanual endoscopic technique….and extended it to corpus callosotomy and hemispherotomy.”
“These two surgical procedures have long been effective in controlling intractable seizures by ’disconnecting’ the area of the brain where the seizures originate from the normal functioning brain. In the past, however, the procedure required large skull-opening surgery, significant blood loss and a prolonged post-operative course. The new endoscopic version will allow neurosurgeons to enter the skull through a much smaller (2.5-3 centimeters) incision, faster healing time, less pain and a shorter hospital stay,” said Steven Ham, D.O., chief of Pediatric Neurosurgery at the Children’s Hospital of Michigan. “This work is pioneering and the result of thoughtful innovation.”
Children’s Hospital of Michigan Surgeon-in-Chief Joseph L. Lelli, M.D., said the breakthrough by the Children’s Hospital of Michigan neurosurgeons is “a significant treatment advance for pediatric neurosurgery and is particularly encouraging for clinicians everywhere who treat intractable epileptic seizures in children.”
“Dr. Sood’s many years of surgical experience and clinical research in finding better therapies for childhood epilepsy were a key factor in the breakthrough,” he added. “They also serve to underline our passionate commitment to clinical research as a crucially important element in our continuing effort to improve patient care at the Children’s Hospital of Michigan.”
A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behavior, or movement. Seizures affect persons of all ages, but are particularly common in childhood. There are many causes of seizures in children, including epilepsy; high fever (febrile seizures); head injuries; infections (e.g., malaria, meningitis, and gastrointestinal illness); metabolic, neurodevelopmental, and cardiovascular conditions; and complications associated with birth.[1–3] Outcomes associated with single or recurring seizures in children vary by seizure type (febrile compared with nonfebrile) and multiple risk factors (age, illness, family history, and family context). Outcomes range from no complications to increased risk for behavioral problems, epilepsy, or sudden unexpected death.[3–6] No nationally representative estimates have been reported for the number of U.S. children and adolescents with seizures, co-occurring conditions, or health service utilization. To address these information gaps, CDC analyzed combined data on children and adolescents aged 6–17 years from the National Health Interview Survey (NHIS) for the period 2010–2014. Overall, 0.7% of children and adolescents (weighted national estimate = 336,000) were reported to have had at least one seizure during the preceding year. Compared with children and adolescents without seizures, a higher percentage of those with seizures were socially and economically disadvantaged. Children and adolescents with seizures had higher prevalences of various mental, developmental, physical, and functional co-occurring conditions than those without seizures; however, only 65.6% of those with seizures had visited a medical specialist (defined as a medical doctor who specializes in a particular medical disease or problem, other than an obstetrician/gynecologist, psychiatrist, or ophthalmologist) during the preceding 12 months. Public health agencies can work with other health and human service agencies to raise awareness about childhood seizures, implement strategies to prevent known causes and risk factors for seizures, study the associations between sociodemographic characteristics and seizure incidence, and ensure linkages for children with seizures to appropriate clinical and community providers.
NHIS is an ongoing annual, nationally representative multistage household survey of the U.S. civilian noninstitutionalized population (http://www.cdc.gov/nchs/nhis/about_nhis.htm). CDC analyzed combined 2010–2014 NHIS data from the Sample Child component (questions asked about one randomly selected child from each family in the NHIS), with an average final response rate of 70%. Because these data do not distinguish the relatively large proportion of young children who experience usually benign febrile seizures* from those who have seizures of other etiologies, only children and adolescents aged 6–17 years were selected for analysis. Those whose parents provided a “Yes” answer to the survey question, “During the past 12 months, has [your child] had any of the following conditions?” and indicated “seizures” were identified as respondents with seizures.
Multiple outcomes reported by parents of those with and without seizures were examined, including indicators of food insecurity; co-occurring conditions (e.g., neurodevelopmental disabilities, recent infectious illnesses), functional limitations, and taking prescription medications; barriers to care, represented by delaying getting care and being unable to afford care in the past 12 months; access to care or health service utilization in the past 12 months; and the number of missed school days associated with any illness or injury.
Multiple logistic regression was used to calculate the prevalences and 95% confidence intervals (CI) of co-occurring conditions and barriers and access to care, adjusted by sex, race/ethnicity, family poverty income ratio,† and mother’s highest level of education, for children with and without seizures. Statistical software was used to account for the NHIS complex survey design and sample child weights. Prevalences were considered statistically significantly different if their CIs did not overlap.
During 2010–2014, parents of 0.7% of children and adolescents aged 6–17 years (weighted national estimate = 336,000) reported that their child had seizures during the past 12 months ( Table 1 ). Children and adolescents with seizures were significantly more likely than those without seizures to live in poverty and low-income families or households (41.6% compared with 28.6%), and were less likely to have mothers or fathers with a bachelor’s degree or higher (20.4% compared with 30.6% and 22.4% compared with 34.0%, respectively), or to live in nuclear families or households§ (30.3% compared with 41.9%). Parents of children with seizures also were more likely than parents of children without seizures to report worrying that food would run out (34.5% compared with 22.9%) or that food they bought would not last until they had money to get more (30.9% compared with 19.2%).
Co-occurring conditions were generally more frequently reported by parents of children and adolescents with seizures than by those without seizures ( Table 2 ). Children with seizures had higher reported prevalences of mental or developmental co-occurring conditions, including learning disabilities (43.7% compared with 8.2%); other types of developmental delay (32.3% compared with 4.3%); intellectual disability (22.9% compared with 1.0%); and attention deficit hyperactivity disorder/attention deficit disorder (19.3% compared with 10.3%) than did children without seizures. Parents of children with seizures more frequently reported that their children had headaches or migraines (23.7% compared with 7.0%), hay fever (19.0% compared with 11.2%), and stuttering or stammering (11.3% compared with 1.6%). In addition, children with seizures were more frequently reported to have an impairment or health problem that limited their abilities to crawl, walk, run, or play (23.7% compared with 1.9%); to require special equipment because of impairment or health problems (21.4% compared with 1.1%); and to have taken prescription medication for ≥3 months (68.7% compared with 15.6%) ( Table 2 ).
A significantly higher percentage of parents of children and adolescents with seizures reported delays in getting health care than did parents of children without seizures (14.4% compared with 8.8%) ( Table 3 ). Children and adolescents with seizures were significantly more likely to see different types of health care providers, but 34.4% had not seen a medical specialist during the past 12 months. During the same time period, 41.0% of children and adolescents with seizures visited an emergency department, compared with 15.4% of children and adolescents without seizures. Children and adolescents with seizures reportedly missed six or more school days associated with any illness or injury significantly more frequently than did children and adolescents without seizures (41.9% compared with 14.3%) ( Table 3 ).
[ARTICLE] Game Analysis, Validation, and Potential Application of EyeToy Play and Play 2 to Upper-Extremity Rehabilitation – Full Text PDF
Objective: To describe and analyze the potential use of games in the commercially available EyeToy Play and EyeToy Play 2 on required/targeted training skills, and feedback provided for clinical application.
Methods: A summary table including all games was created. Two movement experts naïve to the software validated required/targeted training skills and feedback for 10 randomly selected games. Ten healthy school-aged children played to further validate the required/targeted training skills.
Results: All but two (muscular and cardiovascular endurance) had excellent agreement in required/targeted training skills, and there was 100% agreement on feedback. Children’s performance in required/targeted training skills (number of unilateral reaching and bilateral reaching, speed, muscular endurance, and cardiovascular endurance) significantly differed between games (p<.05).
Conclusion: EyeToy Play games could be used to train children’s arm function. However, a careful evaluation of the games is needed since performance might not be consistent between players and therapists’ interpretation.