The Pediatric Measure of Participation (PMoP) short forms.

STUDY DESIGN: Multi-center cross-sectional cohort study. OBJECTIVES: The objectives of this study were to develop and validate short forms (SFs) of participation for child- and parent-reported outcomes following spinal cord injury (SCI). SETTING: Three pediatric orthopedic hospitals in the United States. METHODS: The expert panel used calibration data from the pediatric computerized adaptive test (CAT) development study (convenience sample of 381 children and adolescents with SCI and 322 parents or caregivers) to select SF items. The panel selected items for two domains (participation self-relevant to what I want to do; participation friends-relevant to what my friends do), with parent and child versions for each domain. Psychometric analyses included group reliability, Cronbach's alpha, agreement (SFs and item banks), percent of sample with highest (ceiling) and lowest (floor) scores by level of lesion (paraplegia/tetraplegia), and test information function. RESULTS: Group reliability and Cronbach's alpha values are acceptable (0.74-0.92) and agreement (intraclass correlation coefficients for SFs and total item banks) is strong (0.89-0.95). Floor effects were minimal for people with tetraplegia and paraplegia (0-1.19%). Ceiling effects were minimal for people with tetraplegia (0-3.13%) and slightly higher, but acceptable, for people with paraplegia (8.06-14.02%). Test information function for the SFs was sufficiently high over the range of scores for the majority of the sample. CONCLUSION: Pediatric Measure of Participation (PMoP) SFs are acceptable for use when CATs are not feasible. SPONSORSHIP: The study was funded by the Shriners Hospitals for Children Research Grant 79142 (Mulcahey, PI) and the Boston ROC Grant 5R24HD065688-05 (Jette, PI).

Predicting elementary school participation in children with disabilities.

OBJECTIVE: To identify predictors of participation in school activities from two sets of functional variables using classification and regression tree analysis. DESIGN: Relational study. PARTICIPANTS: A nationwide sample of 341 children with various disabling conditions, including physical and cognitive/behavioral types of impairment and various severity levels. Children attended public elementary school in 40 states in the United States. MAIN OUTCOME MEASURE: Overall participation in elementary school, combining children's participation in six different environments (transportation, transitions, classroom, cafeteria, bathroom, and playground), as measured by the newly developed School Function Assessment. The children were dichotomized into full (n = 117) and limited (n = 224) participation categories. RESULTS: Two classification trees were developed identifying a small set of predictors from variables measuring performance of functional tasks and discrete activities. Final predictive models included physical and cognitive-behavioral variables, suggested important interactions among predictors, and identified meaningful cut-off points that classified the sample into the outcome categories with about 85% accuracy. CONCLUSIONS: Limited participation was predicted by information about children's physical capabilities. Full participation was predicted by a combination of physical and cognitive-behavioral variables. Findings underscore the relative utility of functional performance compared with impairment information to predict the outcome, and suggest pathways of influence to consider in future research and intervention efforts.

Neurobehavioral functioning of healthy preterm infants of varying gestational ages.

Little information is available regarding the behavioral repertoire of healthy, yet prematurely born, infants. To address this problem, the Assessment of Preterm Infants' Behavior (APIB) was used 10 to 14 days after birth in a cross-sectional comparison of 42 healthy newborn infants: 16 full-term infants (gestational age at birth [GA] = 40 weeks), 13 close to full-term infants (GA = 37 weeks), and 13 preterm infants (GA = 34 weeks). Groups differed on four background variables that were used as covariates in subsequent analyses. Significant group differences were found on 12 of 29 outcome variables, including measures of autonomic, motor, state, attention/interaction, and self-regulatory systems, as well as a measure of overall behavioral organization. Pairwise comparison showed that preterm and full-term infants differed on all 12 variables whereas preterm and close to full-term infants differed on 11 of the 12 variables. Furthermore, full-term and close to full-term infants differed on 4 of the 12 variables, including measures of the autonomic, motor, and state systems. Full-term and close to full-term infants were behaviorally more similar to one another than either group was to the preterm infants, yet there were important differences even between full-term and close to full-term infants.

Therapist-child interaction in the middle minutes of sensory integration treatment.

The purpose of this study was to describe the management of challenge during therapist-child interaction in sensory integration treatment. This descriptive and relational study of the middle minutes of treatment sessions partially replicated an earlier study of the beginning minutes. One-minute videotape clips taken from the middle minutes of 38 treatment sessions were shown to therapist judges who rated qualities of therapist and child behavior. Two patterns emerged from the correlations of ratings: work and playfulness. Work for the child involved trying hard, cooperating and seeking assistance, whereas work for the therapist involved assisting and guiding the child. Play for the child included enjoying the activity, being successful and confident, and trying hard. For the therapist, play involved being creative and behaving playfully. Patterns of work and play were different across different levels of challenge to the child.

Symbolic play language during sensory integration treatment.

OBJECTIVE: Clinical writings on sensory integration treatment and theory have long professed that play serves as an important means of implementing treatment goals. However, to date, there has been little research that examines this aspect of the intervention. With the use of play language as an indicator for the occurrence of play, this study examined the frequency and characteristics associated with symbolic play language that therapists and children use during sensory integration therapy. This study is part of an ongoing research program designed to examine therapist-child interactions. METHOD: The frequency of symbolic play language observed in 41 videotaped treatment sessions of therapist-child dyads (21 children, 12 therapists) was recorded with the Challenge Coding System. The presence of symbolic play language was recorded if the child or therapist used language that incorporated the child, therapist, equipment, or activity into a symbolic or pretend play theme. The frequency of symbolic play language and percentage of time spent using play language were calculated. Associations among frequency of play language, child age, and behavior during the session (e.g., seeking assistance, cooperation) were also examined. RESULTS: Symbolic play language proved to be a major feature of sensory integration treatment sessions. It also correlated with child age and with some features associated with therapeutic interactions (i.e., child tries hard, child seeks assistance, therapist assists child, therapist modifies activity, therapist structures activity). CONCLUSION: The results suggest that these therapists used play language frequently and that this usage may support children in sensory integrative therapy to successfully accomplish activities.

Competency beliefs and occupational role behavior among adolescents: explication of the personal causation construct.

According to the Model of Human Occupation (MOHO), beliefs regarding competency can influence whether a person's occupational role behavior is adaptive or maladaptive. Such beliefs are considered to be part of a person's sense of "personal causation." This article reviews some of the theoretical underpinnings of the personal causation construct. Issues addressed are the distinction between competency beliefs and locus of control (another aspect of personal causation according to the MOHO); the domain-specific nature of competency beliefs; and, in particular, the evidence for a relationship between competency beliefs and actual behavior. The article focuses on competency beliefs and their relationship to three domains of occupational behavior that have relevance for adolescents: academic ability, social competence, and physical competence. Implications for clinical practice with adolescents with psychiatric disorders are addressed.

Predictors of functional outcome among adolescents and young adults with psychotic disorders.

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.

Measuring physical disablement: the contextual challenge.

Context is a fundamental consideration in physical therapy assessment and in the interpretation of physical disablement. Specification of context may include physical requirements of a task such as the demands for speed or a specific degree of accuracy, or the social context in which an activity is performed such as dressing for work versus dressing for leisure activities. Context also encompasses individual factors such as the importance of particular activities within the person's culture or value system, or the specific types of roles requiring physical functioning that a person resumes upon discharge from physical therapy. Data are presented to illustrate the differences in performance across related physical tasks and between self-care and mobility tasks in home and school settings in children with severe functional delays. These data highlight the potential impact of context on performance. Implications for future development of functional assessments are discussed, particularly in light of the importance of incorporating contextual information in the clinical interpretation of disablement outcomes for patient groups and individual patients.

Functional performance of young children after traumatic brain injury: a 6-month follow-up study.

OBJECTIVES: A follow-up study is reported of 40 children between the ages of 1 month and 5.6 years who had sustained a brain injury either with (n = 11) or without (n = 29) additional injuries. METHOD: Children and their families were assessed at both 1 and 6 months after hospital discharge with standardized measures of functional performance and family functioning, including the Child Behavior Checklist, the Pediatric Evaluation of Disability Inventory, and the Impact on Family Scale. In addition to within-group analyses, functional outcome was compared to that of a group of 17 children who had sustained non-central nervous system injuries. RESULTS: Mean scores for both groups of injured children were within the average range at both 1-month and 6-month follow-up testing. There was a general trend toward improved performance across the follow-up period, although only a few of these changes reached statistical significance. The effect of the injury as reported by the family was significantly associated with children's function as reflected by number of behavior problems and increased need for caregiver assistance. CONCLUSION: Results point to the need for systematic follow-up of young children after brain injury using sensitive measures to enable early identification of children whose further development may be at risk and to provide support to families whose children are displaying changes in functional behavior.

Current concepts of children's perceptions of control.

Beliefs about control have been identified as an important aspect of the occupational therapy evaluation process because of their potential influence over the course of action chosen. This paper reviews the current status of research and theory in this area as it relates to children. Issues addressed include the drawbacks of the downward extension of adult theoretical models and tests to children, the multidimensionality of perceived control, and the relation between cognitive development and changes in beliefs. Recent revisions in theoretical models and new measures that provide more differentiated information on children's beliefs about causality and personal efficacy are reviewed. The implications for the selection of instruments and interpretation of results for the assessment of children's perceived control in clinical practice are discussed.

The flavonoid tangeretin inhibits invasion of MO4 mouse cells into embryonic chick heart in vitro.

Tangeretin, a flavonoid from citrus plants, was found to inhibit the invasion of MO4 cells (Kirsten murine sarcoma virus transformed fetal mouse cells) into embryonic chick heart fragments in vitro. The flavonoid appeared to be chemically stable in tissue culture medium, and the anti-invasive effect was reversible on omission of the molecule from the medium. Unlike (+)-catechin, another anti-invasive flavonoid, tangeretin bound poorly to extracellular matrix. It did not alter fucosylated surface glycopeptides of MO4 cells. Tangeretin seemed not to act as a microtubule inhibitor, as immunocytochemistry revealed no disturbance of the cytoplasmic microtubule complex. However, at anti-invasive concentrations of tangeretin, cell proliferation and thymidine incorporation appeared to be inhibited. When cultured on an artificial substrate, treated MO4 cells were less elongated, covered a larger surface area and exhibited a slower directional migration than untreated cells. From the decrease in ATP content in MO4 cells after tangeretin treatment, we deduce that this flavonoid inhibits a number of intracellular processes, which leads to an inhibition of cell motility and hence of invasion.

Distribution pattern of psoriatic keratoblasts: computer-assisted image-analysis for combined evaluation of DNA synthesis and expression of 67 kD keratin polypeptides in the epidermis of stable plaques of psoriasis.

Psoriatic epidermis is characterized by increased DNA synthesis and disturbed differentiation. Even though these processes are closely associated, most investigations do not give insight into temporal/spatial relationships between both events. We previously developed a double labeling method for the simultaneous demonstration of the germinative and differentiated epidermal compartments in normal human skin by using tritium-labeled thymidine ([3H] Thd) incorporation and immunoperoxidase staining of 67 kD keratin polypeptides. In this paper we report the results of combined evaluation of these compartments in stable plaques of psoriasis. Scanning of skin sections with an automatic image analyzer allows objective quantification of areas of total epidermis, 67 kD+ differentiated epidermis and numbers of [3H] Thdr+ nuclei. Our data indicate that the 67 kD- undifferentiated psoriatic epidermis is expanded. Increased numbers of [3H] Thd+ basal and suprabasal psoriatic keratinocytes are present and most of them (97.9%) pertain to the 67 kD- compartment. Keratin identification in scales taken from the same sites showed a variable but distinct decrease of 67 kD keratin polypeptides. Hence, the hyperplastic epidermis of stable plaques of psoriasis is characterized by the presence of increased numbers of [3H] Thd+ cells, which primarily belong to the undifferentiated (67 kD-) basal and suprabasal compartments, especially in the lowermost parts of the elongated interpapillary rete ridges. These changes are associated with a relative decrease of synthesis of 67 kD polypeptides and the presence in the scales of keratins that confer a characteristic hyperproliferative epidermal keratin pattern to the psoriatic plaque.

Acid phosphatase activity of cerebrospinal fluid cells in bacterial and abacterial meningitis.

Acid phosphatase staining is performed on cerebrospinal fluid cells of 365 samples from 105 patients with various types of meningitis. This enzyme activity is strongly positive in the early samples of bacterial meningitis, as far as the patients had not received a pretreatment with antibiotics for more than 24 h. It allows monitoring the response to therapy in subsequent samples. Acid phosphatase activity is positive in 2 cases of cryptococcus meningitis. It is negative in all cases of aseptic and Mycoplasma pneumoniae meningitis. The results in herpes encephalitis are variable, depending on the clinical state and the degree of brain destruction. Acid phosphatase staining is a useful and rapid cytological technique for determination of the nature of the meningitis and for monitoring the therapeutical response.

Wernicke's encephalopathy in patients with tumors of the lymphoid-hemopoietic systems.

In three treated patients with a generalized invasion by a tumor of the lymphoid-hemopoietic systems, the neuropathologic findings were consistent with Wernicke's encephalopathy. The clinical picture was atypical, but thiamine deficiency by severe malabsorption was the probable cause of this neurologic complication. It is postulated that the chronic form of Wernicke's encephalopathy must occur more frequently than previously shown in treated and long-standing cases of such kinds of tumors.

Experimental hypokalemia: ultrastructural changes in rat gastrocnemius muscle.

Early ultrastructural changes are studied in rat gastrocnemius muscle during experimental hypokalemia. Vacuolization of muscle fibers is shown to originate in the terminal cisterns of the triads. Important degenerative changes are present in peripheral axons and neuromuscular junctions.