Effectiveness of intensive physiotherapy for gait improvement in stroke: systematic review

Introduction: Stroke is one of the leading causes of functional disability worldwide. Approximately 80% of post-stroke subjects have motor changes. Improvement of gait pattern is one of the main objectives of physiotherapists intervention in these cases. The real challenge in the recovery of gait after stroke is to understand how the remaining neural networks can be modified, to be able to provide response strategies that compensate for the function of the affected structures. There is evidence that intensive training, including physiotherapy, positively influences neuroplasticity, improving mobility, pattern and gait velocity in post-stroke recovery. Objectives: Review and analyze in a systematic way the experimental studies (RCT) that evaluate the effects of Intensive Physiotherapy on gait improvement in poststroke subjects. Methodology: Were only included all RCT performed in humans, without any specific age, that had a clinical diagnosis of stroke at any stage of evolution, with sensorimotor deficits and functional gait changes. The databases used were: Pubmed, PEDro (Physiotherapy Evidence Database) and CENTRAL (Cochrane Center Register of Controlled Trials). Results: After the application of the criteria, there were 4 final studies that were included in the systematic review. 3 of the studies obtained a score of 8 on the PEDro scale and 1 obtained a score of 4. The fact that there is clinical and methodological heterogeneity in the studies evaluated, supports the realization of the current systematic narrative review, without meta-analysis. Discussion: Although the results obtained in the 4 studies are promising, it is important to note that the significant improvements that have been found, should be carefully considered since pilot studies with small samples, such as these, are not designed to test differences between groups, in terms of the effectiveness of the intervention applied. Conclusion: Intensive Physiotherapy seems to be safe and applicable in post-stroke subjects and there are indications that it is effective in improving gait, namely speed, travelled distance and spatiotemporal parameters. However, there is a need to develop more RCTs with larger samples and that evaluate the longterm resultsN/

Social inclusion, care, and belonging of children with spina bifida : perspectives from Uganda

This study presents a situation analysis on daily functioning, caregiving, and inclusion of children with spina bifida in Uganda. 139 children with spina bifida and their families from 4 regions in Uganda participated in this study. Findings show how a complex play of cultural values, globalization and access to biomedical care determines knowledge, and negative attitudes about, and perception of children with spina bifida. Families and private non for profit organisations are the main providers of care of the children. Children with spina bfida had a more negative perception of themselves, were less likely to be in school, and had lower cognitive outcome compared to their siblings. Daily functioning and social inclusion were affected by motor function, incontinence, lack of support for caregivers, low household income, limited resources and knowledge of inclusive teaching, bullying, and inaccessibility of public transport, roads, and buildings. Positive experiences of belonging were found at family and household level and were closely related to the ‘ubuntu’ concept. When a child belongs, the child has a chance to live, to participate, to become, to be included. To facilitate inclusion, families need to be supported, and negative attitudes and behaviour of community members, teachers, and health workers need to be addressed. Key words: disability, inclusion, spina bifida, Uganda, Afric

Fragile X Syndrome: A Family Study

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Science in Medicine. Johannesburg October, 1997Fragile X syndrome is, second to Down syndrome, the commonest form of genetic mental retardation. The aim of this research project was to investigate the impact of having a child with this syndrome on the family relationships. The subjects were 21 mothers and 9 fathers of affected children. The data were collected by means of specially constructed questionnaires in interviews with 19 mothers and 8 fathers and completed by post in three cases. A control group of parents with a normal child, matched for sex and age of the affected child, family size and ethnic groups, was interviewed. The data were computerised and analyzed. The results showed that more experimental parents than controls enjoyed their child’s nature, but disliked the behavioural problems. About half of the experimental parents tended not to reward good behaviour physically. However, although most of the affected children were accepted by their siblings, they had fewer friends and more problems with their peers. Some parents thought that their relationship with their spouse had improved and others thought that it had deteriorated after the affected child’s birth. Most parents in both study groups would request prenatal diagnosis in subsequent pregnancies and significantly more experimental parents than controls would request a termination of pregnancy for an affected fetus. Most parents were satisfied with the health service they received. These results show that family dynamics are disturbed by the presence of a child with FMR. Counsellors and therapists working with these families should be aware of the effects of the syndrome on the familyIT201

Parents of Children Who Had Hypoxic-Ischemic Encephalopathy: A Mixed-Methods, Exploratory Study

Background: There is scant literature addressing the parents of children who had hypoxic-ischemic encephalopathy (HIE). therefore only inferences may be made as to issues of that experience affecting parents. Purpose: The purposes of this study was to uncover the lived experiences of parents of children who had HIE, evaluate issues of stress, depression, coping, and impact of neurologic disability in order to better care for them and thus their families Methods: A parallel, convergent mixed-methods design was used to explore experiences and perceptions of these parents regarding their experiences and life changes. The quantitative strand addressed four research questions which addressed the above stated purpose. The qualitative and quantitative Strands were then explored, seeking areas of convergence and divergence Results: Total impact of disability and the parentally perceived degree of disability were positively correlated (n = 50, p = .013). Parents exhibited significant stress with 31.4% of participants scoring above the 99th percentile for parent-child dysfunction. Of the women, 16.3% exhibited scores consistent with major depression. Interviews yielded six themes: unmet expectations, the source of my strength, life in the negative, outside of reality, lemonade from lemons, and the desires of parents. Areas of convergence, such as stress and depression were well enhanced by parental statements. Areas of divergence indicated that neither the quantitative surveys, nor open-ended interviews were adequate to capture issues of importance in these areas. Finally, there were numerous issues, in terms of communication, which were qualitatively revealed, but were not addressed on surveys. Implications for Practice: Health care providers can discern issues of concern to develop methods to aid parents with the challenges of parenting a child who had HIE. Implications for Research: Further research aimed at assessing and addressing parental needs throughout the caring process may provide clinicians with methods by which more supportive care may be provide

Factors moderating the risk of PTSD, emotional and behavioral problems amongst children in war zones and refugees escaping from warfare

Children who grow up in war zones are typically exposed to multiple stressors including physical harm, intimidation or other forms of psychological trauma. This can also lead to Post Traumatic Stress Disorder. On the other hand, resilient children show no psychiatric distress even when they are exposed to severe traumatic stress. Additionally, the number of refugee children due to warfare reasons is increasing. Past empirical studies have recognized that the process of migration and living life as a refugee is detrimental to the psychological health of young refugees. In this symposium we will examine the prevalence and determinants of resiliency among refugee children and children living in conditions of war and violence. The first study investigated the psychological, social and somatic effects of chronic traumatic experience on Palestinian children over six years (2000-2006). The sample consisted of 1,137 children who completed: Checklist of Traumatic Experiences, Symptoms of PTSD Scale, Network of Psycho-Social Support and Personality Assessment Questionnaire. It was found that 41% of the participants suffered from PTSD. From these 25% suffered from cognitive symptoms; 22% suffered from emotional symptoms; 22% suffered from social behavioral problems; 17% suffered from academic and 14% suffered from somatic symptoms. The support of family, friends, relatives and teachers, and positive personality traits were found to be strong protective factors aiding recovery from trauma and PTSD. The second study evaluated the relation of exposure to war traumas, and violence in the family, community, and school, to PTSD symptoms, emotional and behavioral problems amongst 330 Palestinian children. Results highlight the additive effects of exposure to war traumas and violence in different settings. In addition, it was found that psychosocial support reduced the effects of environmental factors in developing PTSD and behavioral problems. The third study included data from two refugee charity organizations in the UK. There were 200 refugee children coming from war zones and 210 control children (non-refugees). The study aimed to look at a range of factors to assess the differences between the above groups with regards to their well-being and peer and sibling relationships. Results showed that refugee children were significantly more likely to be in the clinical range for total difficulties and to have higher health and physical problems, negative friendship quality and low self esteem compared to the control group. Refugees who were bullied at home and at school were also more likely to develop PTSD symptoms. Protective factors are also discussed in this study. The above studies emphasize the fact that interventionists should consider the full range of sources of environmental risk for PTSD and emotional and behavioral problems and should strengthen the psychosocial support for children in or coming from war zones

Mental Health: A Report of the Surgen General

The past century has witnessed extraordinary progress in our improvement of the public health through medical sciencea nd ambitious, often innovative, approachest o health care services.P revious Surgeons General reports have saluted our gains while continuing to set ever higher benchmarks for the public health. Through much of this era of great challenge and greater achievement, however, concerns regarding mental illness and mental health too often were relegated to the rear of our national consciousness. Tragic and devastating disorders such as schizophrenia, depression and bipolar disorder, Alzheimer’s disease, the mental and behavioral disorders suffered by children, and a range of other mental disorders affect nearly one in five Americans in any year, yet continue too frequently to be spoken of in whispers and shame. Fortunately, leaders in the mental health field-fiercely dedicated advocates, scientists, government officials, and consumers-have been insistent that mental health flow in the mainstream of health. I agree and issue this report in that spirit. This report makes evident that the neuroscience of mental health-a term that encompasses studies extending from molecular events to psychological, behavioral, and societal phenomena-has emerged as one of the most exciting arenas of scientific activity and human inquiry. We recognize that the brain is the integrator of thought, emotion, behavior, and health. Indeed, one of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between “mental’ and “physical” health