ABSTRACT
AIM: Little is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap. METHOD: This was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection. RESULTS: We collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients. CONCLUSION: These findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.
Subject(s)
COVID-19/complications , COVID-19/diagnosis , Intellectual Disability/complications , Motor Disorders/complications , Adolescent , Adult , Aged , Child , Child, Preschool , Female , France , Humans , Infant , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Management of pain is one of the major expectations of children with neurological impairment and their families. The medical literature is poor on this topic accounting for approximately 0.15 % of the publications on pain in general. The objective of the French Pediatric Neurology Society was to review the current knowledge on this topic. Bibliographic research was conducted with PubMed and RefDoc for publications between 1994 and 2014 in French or English. A total of 925 articles were retrieved and 92 were selected for review. Pain is common in this population: a 2-week survey indicated that pain occurs in 50-75 % of children. Pain negatively impacts the quality of life of children and their parents. Children with neurological impairment express their pain with pain expression patterns and specific patterns common to children (change of tone, abnormal movements, spasticity, paradoxical reactions, such as laughter, self-injury or vasomotor dysfunction). Some children with neurological impairment are able to use self-report pain scales. If not, observational measures should be used. Behavioral rating scales specifically designed for this population are more sensitive than others. Scales must be selected according to children's communication skills, type of pain, and the context. Sometimes behavioral changes are the only expression of pain: any change in sleep, tone, feeding, or mood must suggest pain in this population. Management of pain remains difficult. There are no specific guidelines. Procedural pain management guidelines and the usual analgesic drugs can be used in children with neurological impairment with specific concerns regarding tolerance and side effects. These children are particularly at risk for neuropathic pain. A multidisciplinary approach is helpful, involving physicians, nurses, physiotherapists, psychologists and parents.
Subject(s)
Nervous System Diseases/complications , Pain/diagnosis , Child , Humans , Pain/etiology , Pain Management , Pain Measurement , Risk FactorsABSTRACT
PATIENTS AND METHODS: The files of 440 severely handicapped children in the north of France were studied. These children had severe mental retardation and very poor motricity development. The methods of care and nursing were studied. RESULTS: Amounts these patients, 40.4% were in medico-social centers, 30% in non-medico-social centers, and 29.4% lived at home with their parents. Only 6% were unknown by the departmental commission of specialized education (CDES). The rate of prevalence of the severely handicapped children from 5 to 19 years in the north of France was 0.7 per thousand. CONCLUSIONS: Results are compared with those from an INSERM study about handicap patients in 14 French counties.
Subject(s)
Disabled Persons/statistics & numerical data , Intellectual Disability/epidemiology , Motor Skills Disorders/epidemiology , Adolescent , Adult , Child , Child Health Services/organization & administration , Child Health Services/statistics & numerical data , Child, Preschool , Education, Special/statistics & numerical data , France/epidemiology , Humans , Intellectual Disability/nursing , Intellectual Disability/rehabilitation , Motor Skills Disorders/nursing , Motor Skills Disorders/rehabilitation , PrevalenceABSTRACT
BACKGROUND: In 1988, the prevalence of blindness in France was 0.17/1000 and that of amblyopia 0.48/1000. Medical advances in the last 30 years have modified the population of children with visual impairment. PATIENTS AND METHODS: The populations in two specialized schools of the north (340 children and adolescents, 3-20-year-olds) were studied and compared with the literature. RESULTS: Cataracts (13%) and congenital nystagmus (11%) were the two most frequent causes. The children taken in charge had less severe diseases than in the past but needed all the same specialized education. However these schools provided more specialized help for children educated near home, in ordinary schools. The children who were educated in the two specialized schools had more severe diseases or more social problems in their families. CONCLUSION: The education and educative treatment of these children are discussed.
Subject(s)
Disabled Children , Education, Special , Visually Impaired Persons , Adolescent , Adult , Age Factors , Amblyopia/complications , Blindness/complications , Blindness/etiology , Child , Child, Preschool , Eye Diseases/complications , France , Hearing Disorders/complications , Humans , Intellectual Disability/complications , Personality Disorders/complicationsABSTRACT
PURPOSE: The purpose of this analysis was to appreciate the management of visually handicaped children outside specialized structures. We also assessed relays between primary physicians, hospitals and specialized structures. METHOD: A 12-question survey was sent to 144 liberal ophthalmologists of the North of France. The questionnary included 12 questions. We compared the results to litterature. RESULTS: The response-rate was 59.6%. This study indicated that the observed children by the liberal ophtalmologists had more simple diseases than in specialized structures. In hospitals, it seemed that the ophtalmologists diagnosed more severe diseases. These practitioners diagnosed some of these diseases. However some of diagnosis were to late. This study showed that specialized structures were not enough known by the practitioners who detected this handicap and that the families prefered the taking in charge near their home. CONCLUSION: We demonstrated the necessary organisation of precocious and systematic detection, and the necessary information to all practitioners on specialized structures.
