Biomedical subjects

D S Reddihough

Publications and source records attributed to D S Reddihough.

At least 19 recordsLinked to original sources

PubMed2005

Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy.

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Adolescent↗

PubMed2001

Children with sialorrhoea in the absence of neurological abnormalities.

OBJECTIVE: To study the outcome of 21 typically developing children who had been referred to the Saliva Control Clinic at the Royal Children's Hospital, Melbourne. METHOD: Information was collected on various aspects of the child's health, oromotor function and severity of drooling. A follow-up telephone survey was completed by the parents of these children after a mean period of 3.4 years. Information was gathered regarding their child's drooling, current health, oromotor status and the usefulness of the clinic. RESULTS: There was a statistically significant improvement (P < 0.01) in the saliva control measures analysed on follow-up. Thirteen children ceased to drool, three still drooled occasionally, and five continued to drool. The recommendations, mainly advice and referrals to other health professionals, were generally reported to be helpful by the parents. CONCLUSIONS: This cohort of children was established retrospectively, and the study is therefore limited in both numbers and design. The results indicate that some typically developing children may be delayed in the development of saliva control. Parents and professionals can be reassured that this problem is likely to resolve.

Child↗

PubMed2001

Cerebral palsy in Victoria, Australia: mortality and causes of death.

OBJECTIVE: To study the causes of death and the characteristics of children with cerebral palsy that had died over a 25-year period in Victoria, Australia. METHODOLOGY: Names of children that had died were collected from the Victorian Cerebral Palsy Register. Their hospital records were studied and information was gathered about age of death, motor impairment, the presence or absence of associated disabilities and cause of death. RESULTS: One hundred and fifty-five children had died during the period 1970-95. The majority of children had severe spastic quadriplegia, intellectual disability and epilepsy. The predominant cause of death was pneumonia, although for many children who died at home the cause was unknown. CONCLUSIONS: Children with cerebral palsy are a diverse group and those with a severe motor deficit have a reduced life expectancy. Lung disease remains an important cause of morbidity and mortality for this group. Further information about the causes of death is needed, particularly for those children that die at home.

Cause of Death↗

PubMed2000

Syntelencephaly presenting with spastic diplegia.

Two children with syntelencephaly presented with the predominant clinical picture of spastic diplegia. Brain scanning showed deficient formation of the interhemispheric fissure with fusion of occipital and parietal lobes, and an infolding and protrusion of occipital cortex into the telencephalic ventricle. The fusion extended further posteriorly than the cases of "middle interhemispheric fusion" thus far reported. One 7-year old has poor language development, while the other is regarded, at her present age of 3 years, as being cognitively within the normal range.

Agenesis of Corpus Callosum↗

PubMed1998

Six month follow-up: the crucial test of multidisciplinary developmental assessment.

Participation of parents in the developmental assessment process is thought to be beneficial in promoting understanding of their child's disability, and improving consensus between parents and professionals about appropriate intervention programmes. If costly multidisciplinary assessments are to be justified, it is necessary to establish long-term benefits for the child. This highlights a need for research identifying how families use services after diagnostic assessment and what they understand to be important for their child. Poor parent-professional agreement about diagnosis may be a factor contributing to low compliance with recommendations. The major purpose of the current study was to follow-up families 6 months after developmental assessment, in order to investigate use of recommended intervention services. In addition, mothers' opinions about diagnostic findings, recommendations and early intervention services were examined. Subjects were 40 pre-school children who presented for developmental assessment, and their mothers. The majority were diagnosed with developmental problems in multiple domains. Results indicated that most mothers recalled and agreed with their child's diagnosis, but underestimated the severity of developmental delay. Families had not accessed the range of multidisciplinary intervention programmes recommended, given the complexity of their children's disabilities. Speech therapy was considered the service of highest priority by mothers, and was the treatment most frequently received. Mothers recognized a need for more therapeutic interventions for their child. An unexpected finding was the high prevalence of families who organized nonprescribed therapies. Possible explanations of the findings and implications for service delivery are discussed.

Adult↗

PubMed1998

Efficacy of programmes based on Conductive Education for young children with cerebral palsy.

Conductive Education (CE)-based programmes have been introduced to Australia over the past 10 years. The aim of this project was to compare these programmes with traditional neurodevelopmental programmes of rehabilitation for young children (12 to 36 months, mean age 22 months 3 weeks) with cerebral palsy. Thirty-four children were matched by age, motor impairment, and cognitive ability and randomly allocated to CE-based or equivalent-intensity control programmes. Those unwilling to be randomized (32) were still studied but their outcomes were treated separately. Our results indicate that children involved in CE-based programmes made similar progress to those involved in traditional programmes. Statistically significant changes were spread among the four groups of subjects. The findings also endorsed the measures used and the expected maturational effect was detected. Although there were major difficulties in conducting this randomized trial, it was achieved by gathering parental and professional support, and adequate funding.

Cerebral Palsy↗

PubMed1998

Antenatal and perinatal antecedents of moderate and severe spastic cerebral palsy.

Routinely collected perinatal morbidity data were abstracted for 204 cases of moderate and severe spastic cerebral palsy and 816 matched controls. Separate analyses were conducted for cases with birth-weight > or = 2,500 g and birth-weight < 2,500 g. The presence of a congenital abnormality was an important risk factor for cerebral palsy in both groups and further analyses were conducted after dividing the groups according to presence or absence of a congenital abnormality. In the < 2,500 g group, resuscitation needed was clearly identified as a risk factor for cerebral palsy in the group with no congenital abnormalities (adjusted OR=3.4; 95% CI=1.6-7.5) while in the group with congenital abnormalities, none of the risk factors were clearly associated with an increased risk of cerebral palsy. Among the cases with birth-weight > or = 2,500 g, intrauterine hypoxia/birth asphyxia was clearly associated with an increased risk of cerebral palsy (adjusted OR=18.1; 95% CI=1.8-186) in the group with no congenital abnormalities while in the group with congenital abnormalities, none of the factors were clearly associated with an increased risk of cerebral palsy.

Asphyxia Neonatorum↗

PubMed1998

Tubefeeding.

Explore the source record for details and available documents.

Chronic Disease↗

PubMed1996

Early intervention: professional views and referral practices of Australian paediatricians.

OBJECTIVE: To gather information from paediatricians concerning their attitudes to early intervention services for young children with developmental disabilities and to study their referral practices. METHODOLOGY: Two hundred and ninety-five Australian paediatricians completed a postal questionnaire. RESULTS: Paediatricians presented a positive view of early intervention, particularly for its beneficial impact on families, and perceived the quality of services to be comprehensive or adequate. There were few differences between States, or between country or metropolitan areas. Most paediatricians make prompt referrals to early intervention services when a child has an established disability. Referral is much less likely with suspected delay. CONCLUSIONS: Paediatricians are aware of the benefits of early intervention but additional information concerning the role of these services and their significant impact on families and children should be provided.

Australia↗

PubMed1996

Effect of antireflux medication on salivary drooling in children with cerebral palsy.

Salivary drooling is a common and debilitating problem in cerebral palsy (CP). We hypothesised that gastro-oesophageal reflux (GOR) may exacerbate drooling by stimulation of the oesophago-salivary reflex. The aim of our study was to assess the role of GOR in children with CP and severe drooling. Twenty-four children with CP and severe drooling underwent oesophageal pH monitoring (N = 23) or oesophagoscopy (N = 1). Nine had pathological GOR and were enrolled in a double blinded, placebo controlled cross-over trial of medical antireflux therapy (ranitidine plus cisapride) versus placebo. Drooling was measured by semi-quantitative observation (drooling quotient) and a questionnaire-based scoring system (rated by the child's caregivers). Mean drooling quotients and scores for drooling severity and frequency were not significantly different between active medication and placebo. In our study, treatment of pathological GOR did not improve salivary drooling in children with CP.

Adolescent↗

PubMed1995

A pilot evaluation of conductive education-based intervention for children with cerebral palsy: the Tongala project.

OBJECTIVE: To perform an objective evaluation of a programme based on conductive education (CE). METHODOLOGY: Two groups of children with cerebral palsy were studied over 6 months. Eleven children participated in a CE-based programme and nine children received traditional early intervention programmes. Videotapes of the children performing items from the Vulpe Assessment Battery (VAB) were scored by assessors blind to the treatment group. The questionnaire on resources and stress (QRS-F) was administered to the primary caregiver. RESULTS: Few statistically significant results were obtained. There was a trend for the conductive education-based group to make slightly greater gains. The videotaped measures yielded high Chronbach coefficients and high interrater correlation coefficients suggesting that this is a useful method to evaluate progress. CONCLUSIONS: The study was limited by small sample size, the nature of the control group and the lack of random assignment to CE and control groups. It did provide a basis for the development of further research in the area.

Activities of Daily Living↗

PubMed1995

Evaluation of an early childhood programme based on principles of conductive education: the Yooralla project.

OBJECTIVE: To perform an objective evaluation of a programme based on conductive education (CE) for preschool and early school-aged children with cerebral palsy. METHODOLOGY: The progress of 17 children participating in a CE-based programme (the Yooralla programme) was compared with 17 children enrolled in traditional early childhood services. Videotapes of the children performing items from the Vulpe Assessment Battery (VAB) were scored by assessors blind to the treatment group; three standardized tests of cognitive ability were administered; and the questionnaire on resources and stress (QRS-F) was given to the primary caregiver at the beginning and conclusion of 6 months. RESULTS: The Yooralla group improved in motor performance and parental coping variables. Both groups showed improvement on the cognitive measures, with the control group demonstrating slightly greater gains. CONCLUSIONS: Conductive education may benefit the motor development of children with cerebral palsy and provide greater parental support. A randomized control study with adequate subject numbers is necessary to confirm this tentative conclusion.

Activities of Daily Living↗

PubMed1995

Gastro-oesophageal reflux and feeding problems after gastrostomy in children with severe neurological impairment.

This study evaluated the effect of percutaneous endoscopic gastrostomy (PEG) on the feeding problems and gastro-oesophageal reflux (GOR) of 30 consecutive children with severe neurological impairment who had PEG between October 1990 and March 1993. Evaluation was by questionnaire, clinical history, examination, 24-hour oesophageal pH monitoring and endoscopy. Gastrostomy placement significantly reduced feeding time, feed-related choking episodes and frequency of chest infections. Family stress was significantly reduced in two-thirds of cases. Significant weight-gain occurred. The clinical severity of GOR was significantly increased in eight patients and fundoplication was required in five. 24-hour oesophageal pH measurements before PEG did not reliably predict subsequently increased GOR. Seven patients died, but their deaths were apparently unrelated to GOR. PEG effectively provides nutrition, improves feed-related stresses, but may exacerbate GOR.

Adolescent↗

PubMed1995

Long-term outcome of saliva-control surgery.

Thirty-nine patients who had undergone transposition of the submandibular ducts and unilateral ligation of a parotid duct for saliva control were followed up six years after surgery. Overall improvement was documented according to a drooling quotient, drooling severity and drooling frequency measures. Despite this superficially favourable outcome, a significant proportion of patients (39 per cent) or their caregivers had not found the surgery helpful. Complications included ranula formation, complaints of dry mouth, difficulty with swallowing, and changes in the consistency of oral secretions. More knowledge is needed of the likely outcomes of this procedure in individual patients, so that appropriate advice can be given and complications minimised.

Adolescent↗

PubMed1994

Early intervention: the professional views and referral practices of paediatricians in Victoria.

Early intervention services for young children with developmental disabilities have developed considerably in the past decade, yet little information is available about the referral practices and views of Australian paediatricians. During 1991, 100 paediatricians in Victoria completed a postal questionnaire designed to gain information regarding their attitudes to early intervention and referral practices. The results indicated that paediatricians had a positive view of early intervention, and perceived the standard and quality of the services in their region as comprehensive (16%) or adequate (54%). They were likely to make prompt referrals in the presence of an established disability (75%), but with suspected developmental delay, many (45%) were likely to wait until the delay was confirmed. Referrals were more often made for intervention for the child rather than for family support. However, paediatricians felt that early intervention had a beneficial effect on family functioning (81%). In general, the results indicate that there seem to be few barriers between paediatricians and the early intervention field.

Attitude of Health Personnel↗

PubMed1994

Development of a clinical assessment of quality of movement for unilateral upper-limb function.

Eleven subjects with cerebral palsy were assessed both with the Melbourne Assessment and by four clinical experts. Comparison of their assessment ratings revealed that the Melbourne Assessment was strongly related to the clinical judgement of the experts. A further 20 subjects were administered the Melbourne Assessment and two occupational therapists scored each subject's performance from videotaped assessments with substantial inter-rater reliability (0.68); intra-rater agreement after two weeks was 0.80. The Melbourne Assessment may provide a satisfactory objective measure of the quality of upper-limb function.

Arm↗

PubMed1994

Comparison of subjective and objective measures of movement performance in children with cerebral palsy.

This study evaluated the use of accelerometry to measure the quality of movement in children with cerebral palsy. Accelerometer scores based on a previously described test were correlated with scores on a newly developed clinical test shown to be both valid and reliable. Low correlations were obtained between clinical test scores and accelerometer scores. Although the accelerometer test has been shown to be effective in distinguishing between able-bodied children and those with cerebral palsy, it is not sufficiently sensitive to distinguish between levels of movement quality in the latter population. The accelerometer may measure a different aspect of movement from that measured by the clinical test, and does not appear to be a valid test of the quality of movement in children with cerebral palsy.

Acceleration↗

PubMed1993

The health care of young adults with cerebral palsy.

OBJECTIVE: To evaluate the health status and provision of health services to young adults with cerebral palsy. RESULTS: Ninety-seven per cent had ongoing health problems. Consultations with most health professionals declined markedly after leaving school. CONCLUSIONS: Young adults with cerebral palsy have considerable, continuing impairment and disability. Lack of contact with health services after they leave school may adversely affect their health status.

Activities of Daily Living↗