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Biomedical subjects

Deborah Kartin

Publications and source records attributed to Deborah Kartin.

11 recordsLinked to original sources
PubMed2006

Working across the boundaries of health professions disciplines in education, research, and service: the University of Washington experience.

The Institute of Medicine's vision for health professions education specifies working together across professions and schools to provide patient-centered care. Improvement in collaborative preparation of health professionals is seen as central to achieving substantial improvement in the quality of health care. In this article, the authors address one central question: How can medical schools work with other health-sciences schools to promote their educational, research, and service missions? The authors summarize the history of the University of Washington (UW) Health Sciences Center in promoting interprofessional collaboration in education, service and research; analyze the key strategic, structural, cultural and technical elements that have promoted success or served as barriers in the development of the UW Center for Health Sciences Interprofessional Education and Research; and suggest strategies that may be transferable to other institutions seeking to implement an interprofessional health sciences program. These include both top-down and bottom-up authority and function in key working groups, institutional policies such as interprofessional course numbers and shared indirect costs, and development of a culture of interprofessionalism among faculty and students across program boundaries.

Biomedical Research↗
PubMed2005

Effect of balance training on muscle activity used in recovery of stability in children with cerebral palsy: a pilot study.

This study explored possible neural mechanisms that contribute to improvements in balance control produced by reactive balance training in children with cerebral palsy (CP). Six children with CP (four males, two females; mean age 9y 4mo), two with spastic hemiplegia (Gross Motor Function Classification System [GMFCS] level I) and four with spastic diplegia (GMFCS level II,) were given 5 days of intensive training in reactive balance control (100 perturbations per day on a moveable force platform). Surface electromyography was used to characterize changes in neuromuscular responses pretraining, immediately posttraining, and 1 month posttraining. Training in reactive balance control resulted in improvements in directional specificity of responses (a basic level of response organization) and other spatial/temporal characteristics including: (1) faster activation of muscle contraction after training, allowing children to recover stability faster; (2) emergence of a distal-proximal muscle sequence; and (3) improved ability to modulate the amplitude of muscle activity (increased amplitude of agonist and decreased amplitude of antagonist, reducing coactivation). Each child with spastic hemiplegia or diplegia showed a different combination of factors that contributed to improved performance; the level of change in neural factors depended on the severity of involvement of the child: hemiplegia vs diplegia, and level of involvement within each diagnostic category.

Adolescent↗
PubMed2004

Muscle responses to seated perturbations for typically developing infants and those at risk for motor delays.

This study examined spatial and temporal organization of muscle activity in response to seated forward platform perturbations in typically developing (TD) infants and in infants at risk for ongoing neuromotor delays. Twelve high-risk (HR) infants (six males, six females) and 12 TD infants (nine males, three females) aged 8 to 10 months (corrected for prematurity), who were all independent sitters, participated in this study. Surface electromyograms recorded muscle responses to forward perturbation in the neck, trunk, and leg (6cm amplitude, 12cm/s). Center of pressure measures were also recorded. The TD infants demonstrated significantly more phasic responses than the HR infants, who had more trials with tonic activity and more trials with no burst of muscle activity (Mann-Whitney U test, two-tailed, p=0.006). The TD infants demonstrated caudalcephalo, directionally appropriate recruitment patterns more often than the HR infants. There were some similarities between the two groups, with no significant difference between any of the center of pressure measures or onset latencies. Results suggest that postural development in HR infants with motor delays is complex. Some elements of seated postural control appear to be developmentally appropriate, e.g. presence of phasic activity in directionally appropriate muscles sequenced in a caudalcephalo pattern. However, frequency of these age appropriate responses was significantly lower in HR infants, who demonstrated many normal, albeit immature, responses, such as cephalocaudally sequenced muscle activity.

Child Development↗
PubMed2004

Assistive technology programming for a young child with profound disabilities: a single-subject study.

BACKGROUND AND PURPOSE: The purpose of this study was to use single-subject research methods, combined with social validation procedures, as part of an evaluation/intervention process exploring the effects of adapted switch-operated devices on self-initiated behaviors of a 6-year-old child with profound multiple disabilities. METHOD: A single-subject withdrawal design with multiple phases, including one alternating treatments phase, was used to investigate the participant's ability to perform selective, voluntary motions as indicators of contingency awareness and preferences. Social validity also was assessed. RESULTS: The child demonstrated the ability to use two switch sites to activate adapted switch-operated devices when a preferred stimulus was contingent on a specific motor action, and she demonstrated the ability to communicate preferences as indicated by more frequent switch activations for one consequence than for a second consequence. Social validity results indicated that both the parents and school personnel generally viewed the evaluation/intervention process as positive. CONCLUSIONS: Single-subject research methods, combined with social validation procedures, can be used effectively in the evaluation/intervention process for children with profound multiple disabilities.

Blindness, Cortical↗
PubMed2003

Pain in persons with cerebral palsy: extension and cross validation.

OBJECTIVE: To cross-validate and extend the assessment of pain in persons with cerebral palsy (CP). DESIGN: Standardized in-person interviews. SETTING: University medical clinics and local residential and community housing for persons with developmental disabilities. PARTICIPANTS: One hundred adults with CP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures of pain intensity, pain interference in daily activities, psychologic function, significance of pain problem, and satisfaction with pain treatment. RESULTS: Sixty-seven (67%) subjects reported 1 or more chronic pain problem(s). Low back, hip, and leg pain were most common. Twenty-four percent reported constant pain; 19% reported that pain occurred daily. Mean pain intensity +/- standard deviation over the previous week on an 11-point scale (0, no pain; 10, pain as bad as could be) was 4.08+/-2.25. Minor interference (2.55+/-3.03; scale range, 0-10) from pain with routine daily activities was reported. Responses to the Satisfaction with Life Scale (n=63) indicated only moderate life satisfaction (18.44+/-8.34; scale range, 5-35) among those with 1 or more pain problem(s). Responses to the Rand Mental Health Inventory (n=65; mean score, 60.65+/-20.36) revealed relatively high levels of psychologic distress in those with chronic pain. Consumer satisfaction with pain management care varied, with 32.8% of the subjects reporting dissatisfaction. CONCLUSIONS: The study findings are consistent with earlier findings concerning pain problems in adults with CP and provide further evidence that pain problems may be overlooked and undertreated in this population.

Activities of Daily Living↗
PubMed2003

Effect of balance training on recovery of stability in children with cerebral palsy.

This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

Adolescent↗
PubMed2003

The relationship between awake positioning and motor performance among infants who slept supine.

PURPOSE: The purpose of this study was to describe the gross motor development of infants who slept supine and spent different amounts of time in the prone position when awake. METHOD: Thirty infants who were six months old and slept supine were evaluated using the Alberta Infant Motor Scale (AIMS) and then divided into two groups: prone (n = 16) and no prone (n = 14) based on the number of times per day they were placed in prone position while awake. RESULTS: The prone group scored higher than the no prone group on the AIMS total scores (U = 36, p = 0.004), total percentile scores (U = 42, p = 0.003), and prone subscale scores (U = 25, p < 0.001). CONCLUSIONS: Gross motor performance as measured by the AIMS was more advanced in infants who slept supine and had been placed in the prone position when awake than in infants who slept supine but had limited or no experience in the prone position while awake. The influence of awake positioning needs to be considered when interpreting the developmental motor performance of infants who are six months old.

Journal Article↗
PubMed2002

Three-year developmental outcomes in children with prenatal alcohol and drug exposure.

PURPOSE: The purpose of this study was to describe the performance of children whose mothers abused alcohol and drugs heavily during pregnancy, using the Bayley Scales of Infant Development Second Edition (BSID-II) at three years, and to examine the effects of study group, prenatal binge alcohol exposure, and prematurity on developmental outcome. METHODS: Children were born to mothers recruited from two large hospitals or through community referral. Hospital recruits were randomly assigned to either a three-year paraprofessional home visitation intervention program (n = 30) or a control group (n = 31). Community recruits were enrolled in the intervention program (n = 35). RESULTS: Among all children the mean BSID-II Mental Developmental Index (MDI) was 84.4 (SD = 14.4) and mean Psychomotor Developmental Index (PDI) was 84.1 (SD = 16.9). Box plots of the MDI and PDI scores by study group, maternal prenatal binge alcohol status, and a binary indicator of prematurity suggested an effect of maternal binge drinking on MDI and PDI scores: children of mothers with a history of binge alcohol consumption have, on average, slightly lower scores. We saw no evidence of a systematic effect of the maternal intervention. CONCLUSIONS: Developmental performance of preschool children exposed to alcohol and drugs prenatally was, on average, substantially lower than expected for age regardless of study group. Although this home visitation intervention has been shown to be effective in helping mothers address a wide spectrum of needs, it is unlikely sufficient to overcome complex developmental risks of children exposed to alcohol and drugs prenatally. The effect of more comprehensive, multidimensional services specifically designed for the children should be investigated within this context.

Journal Article↗
PubMed2002

Pain treatment in persons with cerebral palsy: frequency and helpfulness.

OBJECTIVES: To identify the interventions currently being used by adults with cerebral palsy (CP) for pain management, examine the perceived helpfulness of these interventions, and determine the extent to which these individuals with cerebral palsy-related pain were accessing the services of healthcare providers for the explicit purpose of addressing pain. DESIGN: Retrospective, descriptive study of 64 adults with cerebral palsy-related chronic pain. Subjects ranged in age from 18 to 76 yr and included 35 women and 29 men. Subjects were evaluated by using a protocol-based interview. RESULTS: The study sample sought and used a variety of pain treatments and healthcare providers and rated many of the interventions as being at least moderately helpful. Despite the reported helpfulness of the pain interventions, however, most are only being used by a small subset of the sample. CONCLUSION: The majority of the sample with chronic pain did not access healthcare providers for help in managing their pain. Cerebral palsy-related pain is undertreated in the adult population with cerebral palsy.

Adult↗
PubMedDate not supplied

Early intervention service eligibility: implications of using the Peabody Developmental Motor Scales.

OBJECTIVE: Occupational therapists, as members of early intervention (El) teams, are responsible for contributing to equitable decision making regarding service eligibility. Because the two editions of the Peabody Developmental Motor Scales (PDMS) are often used in this process, it is important to study these measures. Therefore, the purpose of this study was to examine the implications of using different editions of the PDMS (PDMS versus PDMS-2) and different types of scores (standard deviation versus percent delay) when determining children's eligibility for El. METHOD: With testing order counterbalanced, 30 candidates for El evaluation, between 11 months and 34 months corrected age, were tested using both the PDMS and the PDMS-2. RESULTS: Support for El eligibility often differed depending on the edition of the PDMS used and the type of score used. When the PDMS was used, as opposed to the PDMS-2, disagreements occurred 23% to 43% of the time. For all disagreements, scores on the PDMS supported El eligibility, whereas scores on the PDMS-2 did not. When support for service eligibility was compared using percent delay scores versus standard deviation scores, disagreements occurred more often for the PDMS (Gross Motor: 17%; Fine Motor: 23%) than for the PDMS-2 (Gross Motor: 7%; Fine Motor: 3%). CONCLUSIONS: It is important that occupational therapists within a facility, and ideally within a state, identify a single test edition to use as part of the process for determining El eligibility. Also, if standard scores and percent delay scores point to conflicting decisions (eligibility vs. noneligibility), further evaluation and greater reliance on clinical judgment are advised.

Child, Preschool↗