Comparison of the prevalence and impact of health problems of pre-school children with and without cerebral palsy.

BACKGROUND: The range of health problems associated with children with cerebral palsy (CP) is well documented in the literature; however, the existing data are often either reported for samples of children with all types of CP, or stratified by typology of motor disorder, rather than using the Gross Motor Function Classification System (GMFCS), which has been shown to be the most reliable way of classifying children with CP. Furthermore, availability of research on pre-school-aged children (under 5 years) is sparse. The aim of this study is to compare the prevalence and impact of health problems in pre-school children with and without CP, stratified by the GMFCS. METHODS: Parents of 430 pre-school-aged children with CP (243 boys, 187 girls; mean age = 3 years 2 months, SD = 11 months) and 107 typically developing (TD) children (56 boys, 51 girls; mean age = 3 years 4 months, SD = 11 months) participated. Using the consensus definition of CP and the World Health Organization's International Classification of Functioning, Disability and Health, a parent survey was developed to assess the prevalence and impact of 16 health problems. The measure demonstrates good test-retest reliability (ICC > 0.80) and discriminant validity across GMFCS levels (P < 0.001). RESULTS: Both the prevalence and impact of health problems is greater in children with CP compared with TD children (P < 0.001). The number and impact of health problems increase with ascending GMFCS level (P ≤ 0.01), except for the impact of health problems between groups GMFCS I and GMFCS II/III (P= 0.19). Children with CP have an average of between 3.4 and 6.7 health problems, compared with fewer than one in TD children. CONCLUSIONS: Service providers working with pre-school-aged children with CP need to consider health problems and their impact when planning care.

Sleep health New South Wales: chronic sleep restriction and daytime sleepiness.

AIMS: The aim of this study was to provide the first population-based descriptions of typical sleep duration and the prevalence of chronic sleep restriction and chronic sleepiness in community-dwelling Australian adults. METHODS: Ten thousand subjects randomly selected from the New South Wales electoral roll, half aged 18-24 years and the other half aged 25-64 years were posted a questionnaire asking about sleep behaviour, sleepiness and sleep disorders. RESULTS: Responses were received from 3300 subjects (35.6% response rate). The mean +/- standard deviation of sleep duration was 7.25 +/- 1.48 h/night during the week and 7.53 +/- 2.01 h/night in the weekends. Of the working age group, 18.4% reported sleeping less than 6.5 h/night. Chronic daytime sleepiness was present in 11.7%. Logistic modelling indicated that the independent risk factors for excessive daytime sleepiness were being older, sleeping less than 6.5 h per night during the week, getting qualitatively insufficient sleep, having at least one symptom of insomnia and lacking enthusiasm (marker of depression). CONCLUSION: In New South Wales almost one-fifth of the people are chronically sleep restricted and 11.7% are chronically sleepy. Chronic sleepiness was most commonly associated with voluntarily short sleep durations and symptoms of insomnia and depression. If the experimentally observed health effects of sleep restriction also operate at a population level, this prevalence of chronic sleep restriction is likely to have a significant influence on public health in Australia.

Infant motor development and equipment use in the home.

Forty-three mother-infant dyads were recruited to determine the relationship between both total equipment use and the use of individual pieces of equipment and infant motor development. At 8 months of age, total and individual equipment use was determined by parental survey and infant motor development was assessed using the Alberta Infant Motor Scale. Statistically significant correlations were found for the relationships between total equipment use and infant motor development (r = -0.50, P = 0.001) and individual pieces of equipment [exersaucer (r = -0.58, P = 0.001), highchair (r = -0.32, P = 0.04), and infant seat (r = -0.32, P = 0.03)] and infant motor development. These findings suggest that infants who have high equipment use tend to score lower on infant motor development or that infants who have low equipment use tend to score higher on infant motor development. Limitations of this cross-sectional study make it difficult to determine causality between these constructs. If equipment use is found to be causally related to infant motor development and predictive of later motor development in a future prospective study, parental education emphasizing the moderate use of equipment within the home environment might be warranted.

A multivariate model of determinants of motor change for children with cerebral palsy.

The purpose of this article is to describe the development of a theory- and data-based model of determinants of motor change for children with cerebral palsy. The dimensions of human functioning proposed by the World Health Organization, general systems theory, theories of human ecology, and a philosophical approach incorporating family-centered care provide the conceptual framework for the model. The model focuses on relationships among child characteristics (eg, primary and secondary impairments, personality), family ecology (eg, dynamics of family function), and health care services (eg, availability, access, intervention options). Clarification of the complex multivariate and interactive relationships among the multiple child and family determinants, using statistical methods such as structural equation modeling, is necessary before determining how physical therapy intervention can optimize motor outcomes of children with cerebral palsy. We propose that the development and testing of multivariate models is also useful in physical therapy research and in the management of complex chronic conditions other than cerebral palsy. Testing of similar models could provide physical therapists with support for: (1) prognostic discussions with clients and their families, (2) establishment of realistic and attainable goals, and (3) interventions to enhance outcomes for individual clients with a variety of prognostic attributes.

Early motor development of breech- and cephalic-presenting infants.

OBJECTIVE: This study was conducted to determine whether breech-presenting infants have a different pattern of early neuromotor development than cephalic-presenting infants--regardless of mode of delivery-thus explaining both the failure to assume cephalic version at the end of gestation and the higher rates of childhood motor impairments associated with breech presentation. METHODS: Ninety morphologically normal, term, breech-presenting singletons with birthweights greater than 2,500 g were paired with a similar cephalic-presenting infant, matched for gender and mode of delivery (n = 180; 100 delivered abdominally and 80 delivered vaginally). Data on neurological status (Neurological Assessment of the Preterm and Full-term Newborn Infant) and motor performance (Alberta Infant Motor Scale, Peabody Developmental Motor Scales, and age of walking) were collected prospectively over the first 18 months of life. This study was designed with a power of .80 to detect a "medium" effect size for motor development using the Alberta Infant Motor Scale. The data were analyzed using analysis of variance techniques. RESULTS: Breech-presenting infants had minor transient differences compared with cephalic-presenting infants. First, they had more open popliteal angles at birth (P < .001). Second, they had significantly lower motor scores at 6 weeks than the normative sample (P < .001). At 18 months, three infants were diagnosed with neurological problems, all of whom were delivered electively in the cesarean-breech group. CONCLUSION: As a group, breech-presenting infants do not have a persistent, inherently different pattern of motor development than cephalic-presenting infants. Mode of delivery did not explain the excess neuromotor impairment detected in the subgroup of breech infants.

45,X/47,XYY mosaicism: clinical discrepancy between prenatally and postnatally diagnosed cases.

45,X/47,XYY mosaicism is a rare chromosomal disorder with clinical information limited to 11 postnatal cases in the literature and with uncertainty regarding prenatal prediction of phenotype and prognosis. We report on 7 new cases of 45,X/47,XYY mosaicism, three detected prenatally and 4 diagnosed postnatally. A clinical comparison of the cases of 45,X/47,XYY mosaicism is presented together with a literature review.