Children with nocturnal asthma wheeze intermittently during sleep.

Nocturnal asthma indicates poor overall control of asthma and adversely affects the quality of life of the patient. The purpose of the present study was to compare the objective measurement of nocturnal wheeze with clinical state, recall of symptoms, and changes in lung function. Nine asthmatic children aged 9 to 16 years were followed with an asthma diary and diurnal measurement of peak flow for a week before the nocturnal study; all but two were apparently well controlled. Breath sounds were recorded and analyzed continuously overnight to quantify wheeze using a phonopneumography sensor attached over the trachea. The analytical system (PulmoTrack) utilized an algorithm to detect wheeze and reject interference. The wheeze rate (Tw/Ttot = duration of wheeze/duration of recording) was calculated minute by minute throughout the night. Recordings lasted over 8 hours and all but two children had wheeze lasting for a total time of between 11 and 87 minutes. The pattern of wheezing was very variable during sleep, with episodes of wheeze separated by periods of quiet breathing. There was no relationship between subjective perception of nocturnal asthma, forced expiratory volume in 1 s (FEV(1)) next morning, and the objective measurement of wheeze. Total overnight wheeze was significantly related to the total diary symptom score and to the (small) diurnal variability of peak expiratory flow (PEF). Four of the seven children with asthma who were apparently well controlled had considerable amounts of wheeze during the night that was episodic in nature and unrelated to conventional measures of lung function or nocturnal symptoms.

Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice.

PURPOSE: This paper describes how pediatric physical therapists can utilize the enablement framework, embraced by the World Health Organization in the current International Classification of Functioning, Disability, and Health (ICF). The ICF can guide clinical reasoning related to enhancing participation in desired activities for children with disabilities. In the ICF framework, participation reflects the person's engagement in important life situations. By emphasizing what the person can do in valued contexts, the enablement framework is a positive complement to a focus on functional limitations and disability of the disablement model. SUMMARY OF KEY POINTS: Current conceptual frameworks and policies advocate attention to children's participation. Legislation (Individuals with Disabilities Education Act, Amendments of 1991 and 1997 and the Americans with Disabilities Act of 1990), the Guide to Physical Therapist Practice, and motor control and action perspectives all support the inclusion of children with disabilities in natural environments. These frameworks and laws can guide therapists' clinical reasoning to focus on children's participation in desired activities during the evaluation, goal-setting, and intervention process. A case study of a child with spastic diplegia illustrates how pediatric physical therapists can apply the enablement framework to develop meaningful goals and interventions focused on enhancing the child's participation in desired activities. CONCLUSIONS: Adoption of an enablement perspective may help pediatric physical therapists to focus their evaluations and interventions on promoting children's participation as well as the specific functional activities that enhance participation.