Interrelationships of Functional Status and Health Conditions in Children With Cerebral Palsy: A Descriptive Study.

PURPOSE: To examine the relationship among the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) in children with cerebral palsy (CP) and to determine the average number and effect of health conditions. METHODS: Participants were 671 children with CP aged 2 to 12 years from Canada and the United States. Cross-tabulation of functional classifications and averages were computed for the number and impact of health conditions and comparisons among groups. RESULTS: A total of 78 of the 125 possible classification combinations were recorded. Most frequent were GMFCS I, MACS I, CFCS I; GMFCS I, MACS II, CFCS I; and GMFCS II, MACS II, CFCS I. With lower levels of function, the average number and average impact of associated health conditions increased. CONCLUSIONS: The use of functional profiles across classification systems, with data on the associated health conditions, provides a more comprehensive picture of CP than any single classification or measure

Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System.

AIM: To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists. METHOD: Participants were 664 children with cerebral palsy (CP), 18 months to 12 years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability. RESULTS: Kappa coefficients varied from 0.76 to 0.88 for the GMFCS, 0.59 to 0.73 for the MACS, and 0.57 to 0.77 for the CFCS. For children younger than 4 years of age, level of function did not change for 58.2% on the GMFCS, 30.3% on the MACS, and 39.3% on the CFCS. For children 4 years of age or older, level of function did not change for 72.3% on the GMFCS, 49.1% on the MACS, and 55% on the CFCS. INTERPRETATION: The findings support repeated classification of children over time. The kappa coefficients for the GMFCS are attributed to descriptions of levels for each age band. Consensus classification facilitates discussion between parents and professionals that has implications for shared decision-making. WHAT THIS PAPER ADDS: The findings support repeated classification of children over time. Stability was higher for the Gross Motor Function Classification System than the Manual Ability Classification System and Communication Function Classification System. The function of younger children was more likely to be reclassified. Percentage agreement between parents and therapists using consensus classification varied from 92% to 97%. The intraclass correlation coefficient overestimated stability compared with the weighted kappa coefficient

Performance of physical activities by adolescents with cerebral palsy

Physical Therapy, 87(1): pp. 77-87.Background and Purpose Mobility and self-care are important considerations for successful transition of adolescents with cerebral palsy to adulthood. The purpose of this study was to characterize performance of physical activities from the perspective of adolescents themselves. Subjects The subjects were 156 adolescents with cerebral palsy, 11.6 to 17.7 years of age. Methods A therapist completed the Gross Motor Function Classification System (GMFCS). Adolescents completed the Activities Scale for Kids–Performance Version (ASKp) twice over a 1-year period. Results A repeated-measures analysis of variance indicated a main effect for GMFCS level. The main effect for time and the GMFCS level time interaction were not significant. Post hoc comparisons indicated that ASKp scores differed among all GMFCS levels. Discussion and Conclusion Performance of physical activities by adolescents with cerebral palsy differed based on GMFCS level and did not change over 1 year. The ASKp scores of adolescents in levels II through V suggest the need for physical assistance at times throughout the day. The results have implications for the role of the physical therapist in transition planning

A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy.

In this Perspective, we suggest a process to improve physical and occupational therapists’ and families’ collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by 2 multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP. An evidence-based alternative using prospective cohort studies that produce knowledge of determinants of outcomes important to children and families and methods for developmental monitoring using longitudinal developmental and reference percentile curves to inform individualized care is suggested. Guiding questions are provided to explore how knowledge of determinants and developmental monitoring can inform family-centered, collaborative, strengths-based, and focused service programs to support early development and function. Although this perspective paper is focused on children with CP, the research approach described for collection of useful information and the clinical method of data use may be helpful for people with other heterogeneous chronic health conditions in which physical and occupational therapists face similar challenges

Quality of life and health-related quality of life of adolescents with cerebral palsy

Developmental Medicine & Child Neurology, 49(7): pp. 516-521.This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p<0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p<0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r2). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations

Becoming and staying physically active in adolescents with cerebral palsy: protocol of a qualitative study of facilitators and barriers to physical activity

<p>Abstract</p> <p>Background</p> <p>Adolescents with cerebral palsy (CP) show a reduced physical activity (PA). Currently there are no interventions for adolescents with CP in this critical life phase that optimise and maintain the individuals' physical activity in the long term. To develop such a program it is important to fully understand the factors that influence physical activity behaviours in adolescents with CP. The aim of this study is to explore what makes it easy or hard for adolescents with CP to be and to become physically active.</p> <p>Methods/Design</p> <p>A qualitative research method is chosen to allow adolescents to voice their own opinion. Because we will investigate the lived experiences this study has a phenomenological approach. Thirty ambulatory and non-ambulatory adolescents (aged 10-18 years) with CP, classified as level I to IV on the Gross Motor Function Classification System and 30 parents of adolescents with CP will be invited to participate in one of the 6 focus groups or an individual interview. Therapists from all Children's Treatment Centres in Ontario, Canada, will be asked to fill in a survey. Focus groups will be audio- and videotaped and will approximately take 1.5 hours. The focus groups will be conducted by a facilitator and an assistant. In preparation of the focus groups, participants will fill in a demographic form with additional questions on physical activity. The information gathered from these questions and recent research on barriers and facilitators to physical activity will be used as a starting point for the content of the focus groups. Recordings of the focus groups will be transcribed and a content analysis approach will be used to code the transcripts. A preliminary summary of the coded data will be shared with the participants before themes will be refined.</p> <p>Discussion</p> <p>This study will help us gain insight and understanding of the participants' experiences and perspectives in PA, which can be of great importance when planning programs aimed at helping them to stay or to become physically active.</p

Lung parasites of the genus Metastrongylus Molin, 1861 (Nematoda: Metastrongilidae) in wild boar (Sus scrofa L., 1758) in Central-Italy: An eco-epidemiological study

The respiratory tracts of 57 wild boars (Sus scrofa L. 1758) hunted in central Italy during the 2011/2012 hunting season were examined to detect the presence of lung worms. Fifty-five out of 57 animals (96,5%) were positive. Five species of Metastrongylus were detected and their prevalence was as follows: Metastrongylus asymmetricus Noda, 1973 (91.2%), Metastrongylus confusus Jansen, 1964 and Metastrongylus salmi Gedoelst, 1923 (87.7%), Metastrongylus apri Gmelin, 1790 (80.7%), Metastrongylus pudendotectus Vostokov, 1905 (70.2%). In most cases multi-species infection was observed. The highest parasite load was found in young animals (<1 year old). The Metastrongylus genus sex ratio (M/F) had a range from 1:4.8 to 1:1.5 in favor of females. The Simpson and Shannon-Wiener indices showed a moderate uniformity in parasite community composition. The Fager index highlighted a high degree of affinity among all pairs of selected parasites. The whole parasite population showed an aggregate distribution. Our findings confirm that these parasites are widespread in the wild boar population. The establishment of outdoor domestic pig farming in the same area of the game preserve could pose the risk of infection to domestic animals. Further studies will be needed to understand the factors involved in the presence and prevalence of the intermediate host as well as the population dynamics of Metastrongylus spp

Italian wolves (Canis lupus italicus Altobello, 1921) and molecular detection of taeniids in the Foreste Casentinesi National Park, Northern Italian Apennines

After centuries of massive decline, the recovery of the wolf (Canis lupus italicus) in Italy is a typical conservation success story. To learn more about the possible role of parasites in the wolves' individual and population health and conservation we used non-invasive molecular approaches on fecal samples to identify individual wolves, pack membership, and the taeniids present, some of which are zoonotic. A total of 130 specimens belonging to 54 wolves from eight packs were collected and examined. Taeniid eggs were isolated using a sieving/flotation technique, and the species level was identified by PCR (gene target: 12S rRNA and nad1). Taeniid prevalence was 40.7% for Taenia hydatigena, 22.2% for T. krabbei, 1.8% for T. polyachanta and 5.5% for Echinococcus granulosus. The prevalence of E. granulosus is discussed. Our results show that the taeniid fauna found in wolves from the Foreste Casentinesi National Park is comparable to that described for other domestic and wild Italian canids and provides insights into the wolves' diet and their relationship with the environment

Infezione da Saprolegniaceae in gamberi di fiume, Austropotamobius pallipes complex, in un allevamento sperimentale del nord Italia. / Saprolegniaceae infection in white-clawed crayfish, Austropotamobius pallipes complex, in an experimental hatchery in Northern Italy.

RIASSUNTO - In una troticoltura sperimentale in provincia di Belluno, nel periodo compreso tra autunno 2004 e autunno 2005, \ue8 stata condotta una prova sperimentale di allevamento intensivo di Austropotamobius pallipes complex. Nell\u2019ottobre del 2004 sono stati pescati 32 gamberi (15 maschi e 17 femmine) nella roggia tributaria dell\u2019allevamento. Gli animali sono stati stabulati prima in una vasca di cemento, poi in una di vetroresina. In aprile le femmine con uova (11 individui), sono state spostate in una vasca californiana. Nel giugno 2005, si \ue8 verificata una moria totale dei gamberi nella vasca in vetroresina, che presentava problemi igienici per la permanenza di materiale in decomposizione. In agosto le femmine rimanenti, alla schiusa delle uova, sono state spostate in una vasca simile a quella in cui si \ue8 verificata la mortalit\ue0. Complessivamente 23 gamberi sono stati sottoposti ad indagini sanitarie: 19 ad esame microscopico a fresco, micologico, batteriologico e tutti all\u2019esame istopatologico. All\u2019esame micologico sono state isolate Saprolegniaceae da branchie, arti e addome di tutti i campioni, e Fusarium sp. in un solo esemplare. All\u2019esame istologico si osservava un\u2019abbondante presenza di ife fungine ramificate nelle branchie, nello spessore dei gonopodi, nella porzione ventrale del carapace addominale molle (sternum) e nelle giunzioni delle articolazioni, con gravi lesioni all\u2019ipoderma, reazioni flogistiche e necrosi. La muscolatura e la ghiandola verde talvolta risultavano colonizzate. In alcuni casi le ife si presentavano incapsulate da melanina. La mortalit\ue0 \ue8 stata attribuita ad infezione da Saprolegniaceae, sviluppatesi in maniera abnorme a causa della mancata rimozione dei residui di alimento. SUMMARY - The white-clawed crayfish Austropotamobius pallipes complex, is a protected European native species as it is considered endangered organism. In order to preserve this crustacean, carefully planned restocking programs with production of the juveniles in captivity are essential. An episode of mortality occurred during an intensive crayfish breeding trial from autumn 2004 to autumn 2005 in a North-eastern Italy experimental trout farm. In October 2004, 32 crayfish (15 males and 17 females) captured in Ardo river were housed inside the hatchery, initially in a concrete tank, then were moved to a fibreglass tank, where mating took place. In the spring 2005, 11 barred females were transferred in a Californian tank for the incubation of the eggs. In June 2005 all crayfish in the fiberglass tank died in presence of low hygienic conditions. In August, after the hatching of the eggs, the females were placed in a fiberglass tank, like to the previous, where a total mortality occurred after two weeks. Twenty-three crayfish were submitted at histological and 19 of these at microscopical, mycological, and bacteriological surveys. Saprolegniaceae were isolated from gills, legs and abdomen in all samples, while Fusarium sp. in only one specimen. At the histology coenocytic, branched fungal hyphae were observed in the gonopods, abdominal exoskeletons, eye stalks and in the joints of the legs, with heavy inflammatory lesions and necrosis in the hypoderm. The skeletal muscle and the green gland were sometimes colonized; in some cases the hyphae were surrounded by melanin. The mortality was related to Saprolegniaceae infection, induced by food remnants