The role of sensation for hand function in children with cerebral palsy

This chapter reviews the importance of sensations such as vision, as well as cutaneous sensibility and proprioception for the refined motor control of the hand. Intact sensory receptors provide input needed for modulation and adjustment of movements to ensure that they are accurate and smooth. Cerebral palsy is a non-progressive disorder of movement and posture, often accompanied by disturbances of sensation. For rehabilitation specialists evaluating children with CP in the clinical setting, it is essential that the potential influence of sensory impairments be considered, as it may impact on sensory-motor integration needed for refined hand movements to execute everyday tasks and activities. Therapeutic interventions may focus on maximizing tactile sensibility using sensory retraining and stimulation approaches, with the expectation that sensory input will improve and prehension patterns will become more precise. Conversely, capitalizing on more intact sensory modalities and use of adaptive strategies may be employed to enhance learning of functional hand skills, in spite of sensory-motor deficits. Evidence to support the effectiveness of either remediation or compensatory approaches is lacking, and needs to be addressed in future studies, so as to promote hand function needed to independently execute everyday self-care, school and leisure activities in children and youth with CP

Understanding reneging: Canada's nuclear sharing commitments to NATO and NORAD during the Cold War

How and why do leaders renege on their alliance commitments, despite institutional incentives to cooperate? According to the research on alliance reliability, three types of costs discourage reneging: material costs, reputational costs, and domestic audience costs. These costs are theorized to be especially high for leaders of democracies, junior alliance members, and members of highly institutionalized alliances. Yet, despite these characteristics, Canada's foreign policy related to its nuclear sharing commitments to NATO and NORAD between 1957 to 1984 was uneven. It included several instances of reneging or attempted reneging. Through an in-depth analysis of archival material related to Canada's nuclear alliance commitments, I propose a new theory of reneging. I show that a leader's decision to renege, choice of bargaining strategy in intra-alliance negotiations, and likelihood of success are related to the type of domestic coalition that supports reneging. Leaders with the support of nationalist domestic coalitions face fewer audience costs for reneging and have more leverage when bargaining with allies than those with the support of single-issue or anti-nuclear coalitions. Nationalist coalitions provide negotiators with three key sources of bargaining power in intra-alliance negotiations: a credible threat of withdrawal, a willingness to act unilaterally, and a low vulnerability to being swayed by foreign allies. On the other hand, single-issue coalitions do not wish to leave the alliance, are more willing to act through alliance consensus, and are more vulnerable to allies' attempts to in uence their stance

The long way to bilingualism: the peculiar case of multilingual South Tyrol

In the present contribution we discuss the challenges and the results of learning a second language in South Tyrol, the multilingual border region in northern Italy where the autochthonous German- and Ladinspeaking communities have cohabited with the Italian-speaking community since the end of the First World War. The picture resulting from the data collected in the Kolipsi project (Eurac/DiScoF), an extensive linguistic and psychosocial investigation about South Tyrolean secondary school pupils now in its second edition, gives precious inputs to all entities that intervene in the process of attitude formation and change, ranging from the family environment to politics.En el presente trabajo, debatimos los retos y los resultados del proceso de aprendizaje de segundas lenguas en el Tirol del Sur, la región fronteriza multilingüe del norte de Italia donde las comunidades autóctonas hablantes de alemán y ladino han convivido con la comunidad italohablante desde el fin de la Primera Guerra Mundial. La imagen resultante de los datos recogidos en el proyecto Kolipsi (Eurac/DiScoF), una investigación abarcadora tanto lingüística como psicosocial sobre alumnado de secundaria del Tirol del Sur, proporciona información muy valiosa a todas las entidades que intervienen en el proceso de la formación y el cambio de las actitudes, desde el entorno familiar hasta el ámbito de la política

Pediatric Cerebral Palsy in Africa: Where Are We?

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular therapy input. Relevant guidelines are lacking. In order to guide services for children with existing disabilities, to effectively target the main etiologies and to develop preventive strategies for the continent, research priorities must include multicenter collaborative studies looking at the prevalence, risk factors, and treatment of cerebral palsy

Participation in physical play and leisure : developing a theory- and evidence-based intervention for children with motor impairments

Peer reviewedPublisher PD

Clinicians' caseload management behaviours as explanatory factors in patients' length of time on caseloads : a predictive multilevel study in paediatric community occupational therapy

Peer reviewedPublisher PD

Play and Be Happy? Leisure Participation and Quality of Life in School-Aged Children with Cerebral Palsy

The objective of this study was to examine the association between leisure participation and quality of life (QoL) in school-age children with cerebral palsy (CP). Leisure participation was assessed using the Children’s Assessment of Participation and Enjoyment (CAPE) and QoL using the Pediatric Quality of Life Inventory (PedsQL). Pearson correlation coefficients were calculated to examine the association between CAPE and PedsQL scores, and a multiple linear regression model was used to estimate QoL predictors. Sixty-three children (mean age 9.7±2.1 years; 39 male) in GMFCS levels I–V were included. Intensity of participation in active-physical activities was significantly correlated with both physical (r=0.34, P=0.007) and psychosocial well-being (r=0.31, P=0.01). Intensity and diversity of participation in skill-based activities were negatively correlated with physical well-being (r=−0.39, P=0.001, and r=−0.41, P=0.001, resp.). Diversity and intensity of participation accounted for 32% (P=0.002) of the variance for physical well-being and 48% (P<0.001) when age and gross motor functioning were added. Meaningful and adapted leisure activities appropriate to the child’s skills and preferences may foster QoL

Using shared goal setting to improve access and equity : a mixed methods study of the Good Goals intervention in children's occupational therapy

Peer reviewedPublisher PD

Central Nervous System Changes in Pediatric Heart Failure: A Volumetric Study

Autonomic dysfunction, mood disturbances, and memory deficits appear in pediatric and adult heart failure (HF). Brain areas controlling these functions show injury in adult HF patients, many of whom have comorbid cerebrovascular disease. We examined whether similar brain pathology develops in pediatric subjects without such comorbidities. In this study, high-resolution T1 brain magnetic resonance images were collected from seven severe HF subjects age (age 8–18 years [mean 13]; left ventricular shortening 9 to 19% [median 14%]) and seven age-matched healthy controls (age 8–18 years [mean 13]). After segmentation into gray matter (GM), white matter, and cerebrospinal fluid (CSF), regional volume loss between groups was determined by voxel-based morphometry. GM volume loss appeared on all HF scans, but ischemic changes and infarcts were absent. HF subjects showed greater CSF volume than controls (mean ± SD 0.30 ± 0.04 vs. 0.25 ± 0.04 l, P = 0.03), but total intracranial volume was identical (1.39 ± 0.11 vs. 1.39 ± 0.09 l, P = NS). Regional GM volume reduction appeared in the right and left posterior hippocampus, bilateral mid-insulae, and the superior medial frontal gyrus and mid-cingulate cortex of HF subjects (threshold P < 0.001). No volume-loss sites appeared in control brains. We conclude that pediatric HF patients show brain GM loss in areas similar to those of adult HF subjects. Substantial changes emerged in sites that regulate autonomic function as well as mood, personality and short-term memory. In the absence of thromboembolic disease and many comorbid conditions found in adult HF patients, pediatric HF patients show significant, focal GM volume loss, which may coincide with the multiple neurologic and psychological changes observed in patients with HF