The use of stimulant medication to improve neurocognitive and learning outcomes in children diagnosed with brain tumours: a systematic review.

PURPOSE: Impaired attention is reported in children following treatment for brain tumours (BT). Attention problems impact on information processing and encoding, ultimately leading to academic under-performance. Having been successfully used to manage attention-deficit/hyperactivity disorder (ADHD), stimulants such as methylphenidate (MPH) have been investigated as a beneficial treatment for survivors of childhood BT. In order to develop appropriate strategies to manage late neurocognitive effects, the results of such trials should be evaluated to identify those children most likely to benefit from stimulants. DESIGN: An advanced search was performed across twelve electronic databases for the selection of relevant randomised controlled trials with at least one active stimulant-treated arm. Abstracts were screened for eligibility and data on study design and results were extracted. RESULTS: Of the 5446 records identified, 11 full text articles were assessed for eligibility and seven included in qualitative synthesis. Of the seven papers there were four original trials. Short term outcomes for MPH on objective direct measures of attention and parent/teacher ratings of behaviour were favourable. Observations of side effects indicate that MPH is generally well tolerated. Heterogeneity of study design and outcome measures precluded meta-analysis. CONCLUSION: Despite yielding only a small number of trials with limited sample size, studies investigating the use of stimulant medication in survivors of childhood BT have provided promising outcomes. Current evidence indicates males, older age when treated, and higher baseline intelligence quotient (IQ) were predictive of greater responsiveness to MPH. While encouraging, additional research using a standardised protocol of outcome measures would be beneficial in identifying those likely to benefit from stimulant use. Further, the available data have yet to establish clear evidence for the effectiveness of MPH being translated into improvements on standardised measures of academic achievement.

Planning and structuring spinal cord injury rehabilitation: the needs assessment checklist.

The study aimed to evaluate the Needs Assessment Checklist (NAC) as a clinically appropriate assessment tool for use during spinal cord injury (SCI) rehabilitation. Data were obtained during routine clinical assessments from 193 patients admitted to the National Spinal Injuries Centre, UK, from September 2007 to November 2009. Reliability analyses yielded high internal consistency coefficients (mean α = .889, SD .051), and the mean item internal validity correlation was .534 (SD .136). All subscales of the NAC were found to be highly significant to change between administrations (mean P <.001). Several differences were found on the NAC subscales with respect to gender, age, and mobility. Pain and psychological issues were associated with poorer rehabilitation outcomes. The NAC is demonstrated to be a clinically reliable assessment tool that can be used to structure rehabilitation progress by the generation of person-centered goals. The results highlight the importance of assessing psychological issues and pain during SCI rehabilitation.

Psychological contributions to functional independence: a longitudinal investigation of spinal cord injury rehabilitation.

OBJECTIVES: To investigate the contribution of prerehabilitation appraisals of spinal cord injury (SCI) and patient's coping strategies to the variance in functional independence postdischarge. DESIGN: Longitudinal, cohort study. Patients aged 16 and older and sustaining an SCI were recruited from English- and German-speaking specialist spinal injuries centers. Measures of appraisals, coping strategies, mood, and functional independence were administered on commencing active rehabilitation (12-weeks postinjury) and following hospital discharge (1-y postinjury). SETTING: Specialist SCI rehabilitation centers in England, Germany, Switzerland, and Ireland. PARTICIPANTS: Patients (N=127) completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 years with a mean age of 39.3 years. Demographic and injury characteristics were similar to those reported in international statistics databases. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: FIM (motor subscale). RESULTS: Injury characteristics, age, sex, current depression, and the utilization of the coping strategy, social reliance, at 12-weeks postinjury explained 33.5% of the variance in motor FIM at 1-year postinjury. Strong relationships were found between appraisals, coping styles, mood, and functional outcomes. CONCLUSIONS: The coping strategy, social reliance, was found to contribute significantly when explaining the variance in functional outcomes. Suggestions were made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research is recommended to provide support for the relationship between dependent coping strategies and functional outcomes.