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BACKGROUND: Children with cerebral palsy have difficulties in several areas of functioning, and they need long-lasting rehabilitation with a clear focus on the individual's needs. Finnish guidelines emphasize family-centred service. The values of family-centred service are widely known, but how the principles of family-centred service are adopted in clinical practice is not well documented. The objective of this study was to analyse the family-centred behaviour of professionals working with children and adolescents with cerebral palsy. METHODS: A translated version of the Measure of Processes of Care for Service Providers (MPOC-SP) questionnaire was used to evaluate the family-centred service. The questionnaire was sent to all the professionals in the multidisciplinary rehabilitation teams at all the hospitals and governmental special schools treating children and adolescents with cerebral palsy in Finland (n= 327). Furthermore, 438 physiotherapy service providers working in the children's home region were invited to participate. RESULTS: A total of 201 multidisciplinary team members and 311 physiotherapy service providers completed the questionnaire. Both the team members and the service providers generally rated their family-centred behaviour positively. There was statistically significant difference in how the team members in the multidisciplinary teams self-assessed their family-centred service. Physiotherapists working in multidisciplinary teams rated their family-centred service higher than physiotherapy service providers. The professional's apprehension of family-centred service increased with work experience. CONCLUSIONS: Professional background and professional context seem to affect the apprehension of family-centred service. Also work experience and being part of a multidisciplinary team have an influence on how the professionals embrace the family-centred service delivered. The MPOC-SP can be used to identify areas for improvement.

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BACKGROUND: In order to best meet the needs of both families and their children with cerebral palsy, many rehabilitation service providers have adopted a family-centred service (FCS) approach. In FCS parents are seen as experts on their child's needs, and the family and professionals collaborate in the rehabilitation process. However, parents and service providers might look at FCS from different points of view, i.e. look into the mirror from two different sides. The objective of this study was to explore the degree to which parents experience the service as being family-centred and to which extent the service providers experience their service provision as family-centred. METHODS: A translated version of The Measure of Processes of Care 20 (MPOC-20) questionnaire was used to evaluate parents' experience of FCS, and a Measures of Processes of Care for Service Providers (MPOC-SP) questionnaire was used to evaluate the FCS provided by professionals. Parents visiting two university hospital neuropediatric wards (n= 67) during a 2-month period and who were willing to participate received the questionnaire. Also the service providers working on the same wards (n= 49) were invited to participate. RESULTS: A total of 53 families and 29 service providers completed the questionnaires. Both parents and professionals generally rated the FCS positively. General information was rated lowest and respectful treatment the highest by both parents and professionals. The results revealed that written information about the child's condition, the possibility to choose when to receive information, and contact with other families in the same situation are areas in need of improvement. CONCLUSIONS: The possibility to regularly evaluate services both from the families' and the professionals' perspectives should be part of quality development. Providing general information is a challenge for all service providers. The MPOC questionnaires can be used to highlight important areas of improvement in FCS.

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OBJECTIVES: To identify evidence evaluating the effectiveness of physiotherapy in adolescents (>16 years of age) and adults with cerebral palsy. DATA SOURCES: Systematic literature search from the earliest available time until March 2009. Additional studies were identified through reference and citation tracking. REVIEW METHODS: Two reviewers independently agreed on eligibility, methodological quality and quality of evidence assessment. Standard methods were used for quality assessments. RESULTS: Included were 13 studies, two of which were randomized controlled trials. No article met the criteria for high methodological quality. Evidence of moderate quality was found on gait after strength training. Evidence of low quality was found on balance after strength training and workstation interventions. Low-quality evidence was also found on functionality after strength training in four studies evaluating gross motor capacity. There was very low-quality evidence on increased muscle strength and in outcome measures used to evaluate range of motion. CONCLUSION: Evidence for the effect of physiotherapy on adolescents and adults with cerebral palsy is sparse, and therefore there is an urgent need for well-designed physiotherapeutic trials for these people.

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AIM: To test the validity and reliability of a Swedish version of the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). METHODS: Thirty-two consecutive children/adolescents (2-20 years of age) with cognitive impairment and no verbal communication from four habilitation centres were admitted to the study. Each child's behaviour was observed by a parent or a caregiver and by a physiotherapist in two calm and two painful situations within the child's everyday life. The raters independently assessed and graded the child's behaviour during 5 min according to the translated Swedish version of the NCCPC-PV. The intrarater and interrater reliability were determined, and the construct validity was examined. RESULTS: The results from 202 assessments showed that the construct validity was good: children's behavioural signs differed significantly between situations of pain and situations of calm (p < 0.001). Repeated assessments showed poor agreement both within and between raters [intraclass correlation coefficient (ICC) 0.51-0.65]. The agreement for pain was good (ICC 0.83). CONCLUSION: The Swedish version of the NCCPC-PV can be used for pain assessment in children with cognitive impairments who lack verbal communication. Aspects of reliability need to be further analysed.

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AIM: The motor performance of 165 very low birthweight (VLBW) infants was assessed prospectively at 5, 10, 18 mo and 5.5 y. The aim of the study was to evaluate longitudinal stability of motor development and its association with birthweight (BW), gestational age at birth, intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL) and retinopathy of prematurity (ROP). Furthermore, at 5.5 y the motor behaviour of the VLBW population was compared with that of 124 children born at term. METHODS: The results of each examination were ranked into four levels and the stability of motor development was evaluated on the basis of this ranking. At 5.5 y, VLBW children and controls were compared according to percentiles in the Movement ABC. RESULTS: Fifty-three percent of the VLBW infants displayed a stable motor development. Only PVL and BW contributed significantly to the variability in their motor performance. Forty-seven percent of the infants exhibited an unstable motor development with no association to risk factors. In the entire group only IVH and severe ROP were related to poor motor performance. The majority of the VLBW children performed within the normal range at 5.5 y but their performances were inferior to those of control children. CONCLUSION: VLBW infants with poor early motor performance and/or severe IVH/PVL and ROP should be recruited into individualized follow-up programmes, whereas regular ongoing monitoring by follow-up may be sufficient for those with normal early motor performance and normal ultrasound findings.

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The mouse liver revealed no increased incorporation of [14C]-orotic acid into either the total acid-soluble fraction, the uridine triphosphate or the RNA at 6 and 24 h after partial hepatectomy. In regenerating mouse and rat liver, the concentration of adenosine triphosphate was decreased 15-20% at 6 h, but was in the same range as that of the controls at 24 h. The adenosine monophosphate concentration of mouse liver increased 4-fold and 2-fold at these times after partial hepatectomy, respectively. The results indicate no direct relationship between the energy metabolism and the uptake and incorporation of orotic acid into RNA of regenerating liver. The activity of mouse plasma lactate dehydrogenase 5 (LDH 5) was increased 12-fold at 6 h and 5-fold at 24 h after partial hepatectomy. In rat, the LDH 5 activity was increased 2-fold at 6 h but was not different from that of the controls at 24 h. An increased leakage of LDH 5, possibly related to the decreased energy content of the liver, was thus revealed by the partially hepatectomized mice.

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The uptake and utilization of [6-14C]orotic acid for UTP and RNA synthesis were studied in rat and mouse liver at 24 h after partial hepatectomy. Rat liver concentrated radioactivity relative to blood several-fold better than did mouse liver after both sham-operation and partial hepatectomy. The results showed that in mouse liver, contrary to rat liver, the orotic acid uptake was not increased after the partial hepatectomy. In rat liver, the precursor uptake and the labeling of UTP increased by about 75% whereas the specific radioactivity of RNA increased 2 to 3-fold after the operation, thus indicating an increased RNA synthesis. Mouse liver showed no increased [14C]orotic acid uptake or labeling of UTP or RNA at 24 h after partial hepatectomy.

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