ABSTRACT
A total of 19 children with a history of perinatal stroke were asked how they saw their own motor abilities and disabilities using the Activities Scale for Kids (ASK) performance and capability questionnaires. The median ASK performance score was significantly lower (86.7) than the median ASK capability score (93.4; P = .03), suggesting children felt they were not doing everything they were capable of doing. Performance and capability total scores were not associated with gender or stroke type; lower performance and capability scores were associated with cerebral palsy. Within groups, performance scores were significantly lower than capability scores in girls (P = .02), children with presumed perinatal stroke (P = .02), children with unilateral stroke (P = .02), and children with large versus small branch unilateral middle cerebral artery stroke (P = .03). Further work is needed to understand why these children's performance does not match perceived capability.
Subject(s)
Activities of Daily Living , Disabled Persons/psychology , Self Concept , Stroke/psychology , Adolescent , Child , Female , Humans , Male , Sex Factors , Surveys and QuestionnairesABSTRACT
UNLABELLED: Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. OBJECTIVE: To investigate whether in-home remotely monitored virtual reality videogame-based telerehabilitation in adolescents with hemiplegic cerebral palsy can improve hand function and forearm bone health, and demonstrate alterations in motor circuitry activation. DESIGN: A 3-month proof-of-concept pilot study. SETTING: Virtual reality videogame-based rehabilitation systems were installed in the homes of 3 participants and networked via secure Internet connections to the collaborating engineering school and children's hospital. PARTICIPANTS: Adolescents (N=3) with severe hemiplegic cerebral palsy. INTERVENTION: Participants were asked to exercise the plegic hand 30 minutes a day, 5 days a week using a sensor glove fitted to the plegic hand and attached to a remotely monitored videogame console installed in their home. Games were custom developed, focused on finger movement, and included a screen avatar of the hand. MAIN OUTCOME MEASURES: Standardized occupational therapy assessments, remote assessment of finger range of motion (ROM) based on sensor glove readings, assessment of plegic forearm bone health with dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), and functional magnetic resonance imaging (fMRI) of hand grip task. RESULTS: All 3 adolescents showed improved function of the plegic hand on occupational therapy testing, including increased ability to lift objects, and improved finger ROM based on remote measurements. The 2 adolescents who were most compliant showed improvements in radial bone mineral content and area in the plegic arm. For all 3 adolescents, fMRI during grip task contrasting the plegic and nonplegic hand showed expanded spatial extent of activation at posttreatment relative to baseline in brain motor circuitry (eg, primary motor cortex and cerebellum). CONCLUSIONS: Use of remotely monitored virtual reality videogame telerehabilitation appears to produce improved hand function and forearm bone health (as measured by DXA and pQCT) in adolescents with chronic disability who practice regularly. Improved hand function appears to be reflected in functional brain changes.
Subject(s)
Cerebral Palsy/rehabilitation , Hemiplegia/rehabilitation , Telemedicine/methods , Video Games , Child , Female , Fiber Optic Technology , Hand , Hand Strength , Handwriting , Humans , Internet , Male , Motor Skills , Occupational Therapy , Pilot Projects , Range of Motion, ArticularABSTRACT
Feeding disorders and the association of neonatal feeding disorders with other outcomes were assessed in a cohort of 84 children with neonatal arterial ischemic stroke at a tertiary children's hospital. Both chi(2) tests and Fisher's exact test were used to test associations. Forty-one of 84 children (48.8%) had feeding difficulties. Infarcted vascular territory (unilateral vs bilateral, P = .24) and neonatal seizures (P = .39) were not associated with feeding problems. Children with at least 1 perinatal comorbidity (P = .002, odds ratio = 4.27; 95% confidence interval: 1.65-11.03) and specifically respiratory problems (P = .004, odds ratio = 3.85; 95% confidence interval: 1.49-9.93) were significantly more likely to have feeding problems. Neonatal feeding problems were predictive of feeding problems at 12 to 24 months of age (P = .026, odds ratio = 3.33; 95% confidence interval: 1.12-9.90) but did not predict speech delay (P = .97) or cerebral palsy (P = .70). Feeding problems are important sequelae of neonatal stroke, but neonatal feeding problems in this group do not predict speech delay or cerebral palsy.
