RESUMEN
PURPOSE: The available tools used to describe childhood dystonia tend to offer a monodimensional view of the person functioning, which may overlook significant changes induced by treatment. We applied the International Classification of Functioning, Disability and Health (ICF) perspective to the description of the clinical picture of a dystonic child treated with deep brain stimulation (DBS) to get a more global representation of the treatment effect. METHOD: An 8-year-old child with secondary dystonia was selected within the institutional program for advanced treatment of pediatric dystonia as a candidate for bilateral implantation of electrodes into globus pallidus and chronic stimulation. The International Classification of Functioning, Disability and Health -children and youth (ICF-CY) based project and program format was used by the rehabilitation team to define the clinical picture, rehabilitation objectives, and to verify the outcome. RESULTS: The rehabilitation project and program included 39 ICF categories: 14 body functions, two body structures, 18 activities and participation, and five environment. On such basis we defined the individualized specific rehabilitation objectives and we checked for clinical changes after DBS. CONCLUSION: The ICF-CY format provides a complete and balanced profile of functioning in secondary dystonia treated with DBS and it could offer a novel perspective for outcome evaluation.
Asunto(s)
Estimulación Encefálica Profunda , Evaluación de la Discapacidad , Trastornos Distónicos/diagnóstico , Trastornos Distónicos/rehabilitación , Vocabulario Controlado , Niño , Trastornos Distónicos/etiología , Hipoxia Fetal/complicaciones , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: To follow-up the impact of a format based upon the International Classification of Functioning Disability and Health, version for children and youth (ICF-CY) as a roadmap for in-hospital pediatric neuro-rehabilitation. DESIGN: Longitudinal study in a single Centre testing with impact assessment. SUBJECTS/PATIENTS: The team members of a tertiary care pediatric neuro-rehabilitation unit approaching 88 consecutive patients with various physical and/or neurological conditions. METHODS: A revised version of the protocol ICF-CY based format for rehabilitation projecting and programming was applied for 24 months. Impact on the rehabilitation team was assessed with an ad hoc questionnaire. RESULTS: Fifteen questionnaires were returned, all of them reporting strongly positive judgements. Time constraint was no longer considered the main problem, probably because of a learning effect. Ongoing utilization reduced the time needed and the problems perceived in completing the task. CONCLUSION: This application confirmed that ICF contribute to improve the quality of interdisciplinary work and to share the rehabilitation process between team members and family. Indeed ICF-CY works efficiently as a roadmap for in-hospital pediatric neuro-rehabilitation. Its implementation results in perceived improvements in the process, ongoing utilization reduces the time needed and the problems encountered in completing the task.