ABSTRACT
Background: The Covid-19 pandemic has led to huge disruptions and multi-domain healthcare crisis, with additional impact on children and young people (CYP) affected by Attention Deficit and Hyperactivity Disorder (ADHD). Methods: We conducted an online survey and obtained responses from 62 Paediatricians who provide ADHD services for CYP about their experience of Service disruption and adaptations during the first Covid-19 lockdown in the United Kingdom between March and June 2020. The responses were both quantitative and qualitative. Results: The Paediatricians reported huge service disruptions such that almost half ceased the assessment of new patients with ADHD, and only 5% were able to offer physical monitoring for most patients. However, all respondents had adopted telemedicine, which allowed them to maintain high levels of non-physical service provision for existing patients. The Paediatricians used risk stratification strategies to determine which patients were more likely to benefit from the limited available face to face appointments for physical monitoring. The Paediatricians demonstrated clinical pragmatism to meet the needs of their patients such as starting medication without physical exam especially if the patient's behaviour was so challenging that it was presenting a crisis at home, and setting aside monthly limits for stimulant medications. Some respondents reported helpful cross-service collaborations to support CYP with ADHD and their families. Conclusion: The Covid-19 pandemic has had adverse effect on many CYP with ADHD and caused huge disruption to the ADHD services that support them. As the pandemic continues to cause disruptions to ADHD services, the service adaptations emerging from the literature including some of those identified in this study could be useful to support more stable and sustainable ADHD services, both during and after the pandemic.
ABSTRACT
BackgroundYoung-people with Cerebral Palsy (CP) have been shown to have reduced physical fitness estimated at 15–28% less than healthy age matched children. As a result, they are at an increased risk of developing secondary health consequences due to a reduction in physical activity levels, lower cardiorespiratory capacity, and a decrease in muscle strength. There is limited research investigating the impact of a targeted exercise-programme for these young-people. The aim of this project was to conduct a service evaluation to explore the effects of a community-based, exercise-programme, for young people (age 9–13 years) with CP (GMFCS Levels-I-III).ObjectivesTo design and implement a community-based exercise-programme for young-people with CP.To investigate the impact on physical activity levels using daily step-count data and Physical Activity Questionnaire for Older Children (PAQ-C) scores.To investigate the impact on functional-mobility using Timed-Up-and-Go (TUG) times.To investigate participation scores using the Child and Adolescent Scale of Participation (CASP) scores.MethodsYoung people with CP were identified using inclusion and exclusion criteria from a single centre. Approvals were granted and consent was obtained from all participants and their parents/carers. A weekly, individualised, physiotherapy-led, exercise-programme was completed at a large public leisure centre for six consecutive weeks. Outcome measures were completed to measure changes in physical activity, functional-mobility, and participation at pre-intervention, post-intervention and three-month follow-up.ResultsEight young-people with CP consented and four participants completed the intervention and outcomes. The mean daily step-count increased from post-intervention for three-participants (range -1914.06–2096.86 steps) and was higher on weekdays (range 6410 (SD=±58.35) to 664.49 steps (SD=±1367.92)) than weekend-days (range 461.35 (SD=±67.84) to 5586.64 steps (SD=±539.17)).The PAQ-C-scores increased for all participants post-intervention (within-participant-difference range (WPDR) 0.21 (SD=±0.38) to 0.58 (SD=±0.70)) and varied at follow-up (WPDR -0.46 (SD=±0.72) to 0.69 (SD=±0.80)). The TUG-times improved for two-participants post-intervention (WPDR -24.29 (SD=±6.13) to 1.28 seconds (SD=±0.57)) and was maintained at follow-up (WPDR -23.70 (SD=±6.22) to 1.17 seconds (SD=±0.42)). The CASP-scores improved for three-participants (range 2 to 11) and was maintained at follow-up (2 to 12).ConclusionsThe aim of this project was to explore the feasibility and effects of a community-based exercise-group for young-people with CP. Overall the implementation and integration of the programme into the gym-environment was very successful. Attendance levels were 90% and all participants reported excellent subjective levels of enjoyment. The results of this project demonstrate preliminary, positive evidence for the effectiveness of the intervention on physical activity, functional-mobility, and participation measures in this small sample. The sample size and data collection were unfortunately affected by the Covid-19 pandemic. Therefore, additional data collection will be conducted in the future to further investigate the impact of the programme. It is clear that further studies are required to investigate outcome measures, to record the effects of interventions on physical activity, functional-mobility, and participation in young-people with CP. This preliminary study shows promise for the positive impact of community-based, exercise-programmes and should be considered as an additional option to facilitate young-people with CP to increase their participation, and to incorporate physical activity into their daily lives.
ABSTRACT
1809 Table 1Showing the weekly CVS changes among CYP with ADHDWks_Post CPL$No-PtsAvg-HRΔHRAvg-SBAvg-ΔSBAvg-DiBAvg-ΔDiB11284.41.6116.015.473.414.421180.61.9108.515.271.512.93892.69110.05.375.811.34987.78.2114.28.770.312.151579117.0-1569−9TOTAL4184.84.8112.711.272.512.3Rho−0.20.820.4−0.9−0.7−0.9P value0.750.090.50.04**0.190.04**Legend:Avg – Average (excluding missing readings);No – Number;Pts – ADHD patients;Rho – Spearman Coefficient of correlation;CPL – Covid-19 Pandemic lockdown;HR – Heart Rate;SB – Systolic BP;DiB – Diastolic BP$ Week 1 starting from 26th March 2020;** Statistically significant;Δ Difference between pre- and post-CPL measurements.ConclusionsThe pandemic lockdown was associated with statistically significant increase in the HR, diastolic and systolic BP of all the CYP with A HD. This finding suggests that there was progressively increasing stress experienced during the lockdown by CYP with ADHD.It highlights the need of adequate provisions for effective preventive measures to address the significant stress among CYP during future lockdowns or similar emergencies.This study did not confirm any significant association between different areas of socio-economic deprivation and the observed changes in the CVS status of the CYP.ReferenceMahmood S et al. Non-pharmacological management of hypertension: in the light of current research. Ir J Med Sci 2019 May;188(2):437–452.