633 research outputs found
A quality improvement project: implementing safe sleep practice in a neonatal intensive care unit.
Significance: The American Academy of Pediatrics (AAP) recommends safe sleep practices (SSP) to reduce infant sleep-related deaths. Annually 3,500 babies die due to improper sleeping conditions, and Kentucky is among the lower-performing states for infant sleep safety. The AAP recommends initiating SSP with infants in neonatal intensive care units (NICU) and recently expanded recommendations in 2022. Presently, there is no regulation of healthcare clinician education regarding SSP or role-modeling behavior in the in-patient setting.
Purpose: This scholarly project aimed to improve knowledge and awareness of SSP by improving clinician knowledge and behavior of SSP use in NICU and improving parent education on SSP.
Methods: This Quality improvement project followed the Plan-Do-Study-Act cycle framework in a Level III NICU.
Interventions: Provision of clinician education on the AAP’s recommendations for SSP, pre/post-education assessment to evaluate NICU clinician knowledge and behavior of SSP. Implementation of a process for determining infant eligibility to initiate SSP, staff documentation of SSP initiation, and educational enhancements provided to parents.
Results: From February 2023 to April 2023, 41 NICU clinicians participated in a pre-and post-education assessment. Statistical analysis of the assessment did not indicate significance. However, assessment scores improved. Additionally, 25 chart audits were conducted to evaluate improvements in placing infants in SSP and parent receipt of education. Chart audits revealed improvement in parent education from 33% to 70% and implementing SSP from 18% to 100%.
Discussion: This initiative has shown that educating clinicians improves their knowledge and behavior surrounding SSP implementation
Reciprocal Inhibition Post-stroke is Related to Reflex Excitability and Movement Ability
Objective Decreased reciprocal inhibition (RI) of motor neurons may contribute to spasticity after stroke. However, decreased RI is not a uniform observation among stroke survivors, suggesting that this spinal circuit may be influenced by other stroke-related characteristics. The purpose of this study was to measure RI post-stroke and to examine the relationship between RI and other features of stroke. Methods RI was examined in 15 stroke survivors (PAR) and 10 control subjects by quantifying the effect of peroneal nerve stimulation on soleus H-reflex amplitude. The relationship between RI and age, time post-stroke, lesion side, walking velocity, Fugl-Meyer, Ashworth, and Achilles reflex scores was examined. Results RI was absent and replaced by reciprocal facilitation in 10 of 15 PAR individuals. Reciprocal facilitation was associated with low Fugl-Meyer scores and slow walking velocities but not with hyperactive Achilles tendon reflexes. There was no relationship between RI or reciprocal facilitation and time post-stroke, lesion side, or Ashworth score. Conclusions Decreased RI is not a uniform finding post-stroke and is more closely related to walking ability and movement impairment than to spasticity. Significance Phenomena other than decreased RI may contribute to post-stroke spasticity
Is clumsiness a marker for Asperger syndrome?
Although Asperger syndrome (AS) has been included in the ICD-10 as a distinct category within the pervasive developmental disorders, it is still unclear to what extent it differs from normal-intelligence autism (high-functioning autism; HFA). Persons with AS are said to be particularly clumsy. To test the hypothesis that clumsiness can reliably distinguish AS from autism, the present authors compared 11 patients with AS (ICD-10; 10 males; mean age, 13–6 years; mean IQ, 98) with nine patients with HFA (ICD-10/DSM-III-R; eight males; mean age, 12–9 years; mean IQ, 84). Clumsiness was assessed by the Bruininks-Oseretsky test. Both groups showed problems with coordination and the distribution of standard scores was virtually identical. This suggests that motor clumsiness, as measured by tests of coordination, may not reliably distinguish AS from HFA. However, qualitative differences may occur between the two groups in the manner in which movements are performed. Further research with larger samples may elicit differences into the pattern of motor deficits that occur in autism and AS.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72191/1/j.1365-2788.1994.tb00440.x.pd
Macrocranium and macrencephaly in neurofibromatosis
Data were collected on 52 patients (30 males and 22 females) with neurofibromatosis. Using the volumetric method of Gordon, it was found that 44% of the patients had cranial capacities above the 95th percentile (70% were above the 50th percentile). The presence of intracranial tumors and/or hydrocephalus did not influence skull size. Four patients above the 95th percentile had normal pneumoencephalograms and cerebral angiograms, indicating that the cause of the macrocranium, in some instances at least, is macrencephaly. Volumetric measurement of the sella turcica in 27 of the 52 patients gave results which strongly suggest that idiopathic enlargement of the sella in neurofibromatosis is uncommon, if not rare. Skull films of 26 patients with tuberous sclerosis did not show an increase in cranial capacity similar to that found in neurofibromatosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46770/1/256_2004_Article_BF00347724.pd
Sensorimotor Difficulties Are Associated with the Severity of Autism Spectrum Conditions
Present diagnostic criteria for autism spectrum conditions (ASC) include social communication and interaction difficulties, repetitive behaviour and movement, and atypical sensory responsivity. Few studies have explored the influence of motor coordination and sensory responsivity on severity of ASC symptoms. In the current study, we explore whether sensory responsivity and motor coordination differences can account for the severity of autistic behaviours in children with ASC. 36 children took part: 18 (13 male, 5 female) with ASC (ages 7-16: mean age 9.93 years) and 18 (7 male, 11 female) typically developing (TD) children (ages 6-12; mean age 9.16 years). Both groups completed a battery of assessments that included motor coordination, sensory responsivity, receptive language, non-verbal reasoning and social communication measures Children with ASC also completed the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview – Revised.. Results showed that children with ASC scored significantly lower on receptive language, coordination and sensory responsivity and a sensorimotor subscale, Modulation of Activity (MoA) compared to the TD group. In the ASC group, MoA significantly predicted ASC severity across all ASC measures; receptive language and sensory responsivity significantly predicted parental reported autism measures; and coordination significantly predicted examiner observed reported scores. Additionally, specific associations were found between the somatosensory perceptive modalities and ASC severity. The results show that sensorimotor skills are associated with severity of ASC symptoms; furthering the need to research sensorimotor integration in ASC and also implying that diagnosis of ASC should also include the assessment of both coordination deficit and atypical sensory responsivity
Associations between language development and skin conductance responses to faces and eye gaze in children with autism spectrum disorder
Attention to social stimuli is associated with language development, and arousal is associated with the increased viewing of stimuli. We investigated whether skin conductance responses (SCRs) are associated with language development in ASD: a population that shows abnormalities in both attention to others and language development. A sample of 32 children with ASD (7 y – 15 y; M =9 y) was divided into two groups, based on language onset histories. A typically developing comparison group consisted of 18 age and IQ matched children. SCRs were taken as the participants viewed faces. SCRs differentiated the ASD group based on language onset and were associated with abnormal attention to gaze in infancy and subsequent language development
Holoprosencephaly
Holoprosencephaly (HPE) is a complex brain malformation resulting from incomplete cleavage of the prosencephalon, occurring between the 18th and the 28th day of gestation and affecting both the forebrain and the face. It is estimated to occur in 1/16,000 live births and 1/250 conceptuses. Three ranges of increasing severity are described: lobar, semi-lobar and alobar HPE. Another milder subtype of HPE called middle interhemispheric variant (MIHF) or syntelencephaly is also reported. In most of the cases, facial anomalies are observed in HPE, like cyclopia, proboscis, median or bilateral cleft lip/palate in severe forms, ocular hypotelorism or solitary median maxillary central incisor in minor forms. These latter midline defects can occur without the cerebral malformations and then are called microforms. Children with HPE have many medical problems: developmental delay and feeding difficulties, epilepsy, instability of temperature, heart rate and respiration. Endocrine disorders like diabetes insipidus, adrenal hypoplasia, hypogonadism, thyroid hypoplasia and growth hormone deficiency are frequent. To date, seven genes have been positively implicated in HPE: Sonic hedgehog (SHH), ZIC2, SIX3, TGIF, PTCH, GLI2 and TDGF1. A molecular diagnosis can be performed by gene sequencing and allele quantification for the four main genes SHH, ZIC2, SIX3 and TGIF. Major rearrangements of the subtelomeres can also be identified by multiplex ligation-dependent probe amplification (MLPA). Nevertheless, in about 70% of cases, the molecular basis of the disease remains unknown, suggesting the existence of several other candidate genes or environmental factors. Consequently, a "multiple-hit hypothesis" of genetic and/or environmental factors (like maternal diabetes) has been proposed to account for the extreme clinical variability. In a practical approach, prenatal diagnosis is based on ultrasound and magnetic resonance imaging (MRI) rather than on molecular diagnosis. Treatment is symptomatic and supportive, and requires a multidisciplinary management. Child outcome depends on the HPE severity and the medical and neurological complications associated. Severely affected children have a very poor prognosis. Mildly affected children may exhibit few symptoms and may live a normal life
The Role of Sensorimotor Difficulties in Autism Spectrum Conditions
AbstractIn addition to difficulties in social communication, current diagnostic criteria for autism spectrum conditions (ASC) also incorporate sensorimotor difficulties; repetitive motor movements and atypical reactivity to sensory input (APA, 2013). This paper explores whether sensorimotor difficulties are associated with the development and maintenance of symptoms in ASC. Firstly, studies have shown difficulties coordinating sensory input into planning and executing movement effectively in ASC. Secondly, studies have shown associations between sensory reactivity and motor coordination with core ASC symptoms, suggesting these areas each strongly influence the development of social and communication skills. Thirdly, studies have begun to demonstrate that sensorimotor difficulties in ASC could account for reduced social attention early in development, with a cascading effect on later social, communicative and emotional development. These results suggest that sensorimotor difficulties not only contribute to non-social difficulties such as narrow circumscribed interests, but also to the development of social behaviours such as effectively coordinating eye contact with speech and gesture, interpreting others’ behaviour and responding appropriately. Further research is needed to explore the link between sensory and motor difficulties in ASC, and their contribution to the development and maintenance of ASC
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