Biomedical subjects

Helene M Dumas

Publications and source records attributed to Helene M Dumas.

29 records · Page 2Linked to original sources

PubMed2002

Impairment, disability, and satisfaction outcomes after lower-extremity botulinum toxin a injections for children with cerebral palsy.

PURPOSE: The purpose of this study was to document impairment, disability, and parent satisfaction outcomes for children with cerebral palsy who received botulinum toxin A (BtA) injections. METHODS: Seven children, three to 11 years old, participated in this multiple single-subject AB design study. Impairment, disability, and satisfaction outcomes were documented using passive range of motion measurements, Modified Ashworth Scale scores, and the Canadian Occupational Performance Measure. These outcomes were measured every two weeks during the two-month baseline phase and the four-month intervention phase. Outcomes for each child were graphed and visually analyzed for changes in level, trend, and slope. RESULTS: After BtA injections, all children demonstrated an increase in passive range of motion and a decrease in spasticity in at least some of the injected muscles. Six of the seven children demonstrated improvements in disability and parent satisfaction outcomes. CONCLUSIONS: Improvement in a variety of outcomes may be observed after BtA injections in children with cerebral palsy and lower-extremity spasticity who are ambulatory.

Journal Article↗

PubMed2002

Functional recovery in pediatric traumatic brain injury during inpatient rehabilitation.

OBJECTIVE: To examine changes in functional status of children with traumatic brain injury by identifying the pattern and amount of change between and within the domains of self-care, mobility, and social function during inpatient rehabilitation and to examine the relationships of age and injury severity to functional recovery. DESIGN: Retrospective descriptive study. Seventy-nine children and adolescents with traumatic brain injury were assessed at inpatient rehabilitation hospital admission and discharge by using the Pediatric Evaluation of Disability Inventory's (PEDI) functional skills and caregiver assistance domains of self-care, mobility, and social function. RESULTS: Admission self-care functional levels were significantly greater than mobility and social function for both PEDI scales. At discharge, significant improvement was noted within all three domains and the amount of change between domains was significantly greater for the mobility domain on both scales. Age was not related to the amount of recovery. Admission functional status was moderately negatively correlated to the change in PEDI scores (ranging from r = -0.432 to -0.681). CONCLUSIONS: Variations exist in the recovery of self-care, mobility, and social function capability and independence during inpatient rehabilitation. Self-care was the least affected. Participants showed significant improvement in all domains, with the most recovery in mobility. Children with greater functional deficits demonstrated greater functional gains.

Activities of Daily Living↗

PubMed2002

Clinical findings and resource use of infants and toddlers dependent on oxygen and ventilators.

Medical records were reviewed to describe characteristics, report clinical and resource measures, and determine if differences exist between the diagnostic groups of prematurity and multiple congenital anomalies/neurologic conditions for initial admissions of 37 infants and toddlers to an inpatient pulmonary rehabilitation program. More than 75% of the children had a tracheostomy at admission and discharge. Forty-six percent of the sample was admitted requiring only oxygen, whereas 51% were discharged requiring only oxygen and not mechanical ventilation. Thirty percent of the children weaned to a less invasive mode of ventilation while just under half of the children were discharged home. Between-group comparisons indicated statistically significant differences for nutritional support at discharge (p < or = 0.05) and discharge disposition (p = 0.04). Complete weaning of oxygen or ventilator support during an initial inpatient pulmonary rehabilitation admission occurred less frequently than weaning to a less invasive mode of ventilation. This is an important consideration for referring children to rehabilitation programs, for clinical program improvement activities, and for setting realistic expectations for referral sources, patients and families, clinical staff, and payers. Further study is recommended using clinical data in program planning, in program improvements, and for setting outcome expectations for infants and toddlers dependent on pulmonary technology.

Child, Preschool↗

PubMed2002

Motor skill and mobility recovery outcomes of children and youth with traumatic brain injury.

Traumatic brain injury (TBI) is a major cause of disability in children. Along with other neurological clinical sequelae, children often exhibit motor skill impairment and limitations in functional mobility following TBI. The purpose of this annotated bibliography is to: (1) familiarize therapists with the literature available regarding motor skill and mobility recovery outcomes for children and adolescents with TBI; (2) assist therapists in the selection of motor skill and mobility outcome assessments for use in clinical practice; and (3) provide therapists with comparisons of outcomes for external benchmarking. A number of reports document motor and mobility recovery outcomes as well as recovery in other domains. Studies vary, however, in design, sample size, number and type of outcome assessments used, time since injury at assessment(s), and the consideration of correlating factors such as age at time of injury and injury severity. Further research is needed to describe clinical, satisfaction and resource utilization outcomes, determine outcome predictors, and provide evidence for therapeutic intervention effectiveness.

Brain Injuries↗

PubMedDate not supplied

Re-admissions to inpatient paediatric pulmonary rehabilitation.

OBJECTIVE: To describe re-admission rates, identify reasons for re-admission and examine characteristics of children requiring re-admission to inpatient pulmonary rehabilitation. METHODOLOGY: Retrospective record review of infants and toddlers (less than three years of age) requiring oxygen or ventilator support discharged from an inpatient paediatric pulmonary rehabilitation programme between 1992 and 1999. RESULTS: Forty-one initial admissions resulted in 45 readmissions with a mean re-admission rate of 1.1 (SD = 1.41) re-admissions per child. Children with re-admissions (n = 22, 54%) required significantly more ventilator support (p = 0.001) and nursing care (p = 0.001) and were transferred to acute care more frequently (p = 0.002) than children without re-admissions. One-half of the children re-admitted to inpatient pulmonary rehabilitation were re-admitted two or more times. CONCLUSIONS: Based on this cohort of children, dependence on supplemental oxygen and/or mechanical ventilation and medical complexity may be indicators that children will require re-admission to rehabilitation following a transfer back to acute care. Further examination of re-admission rates and reasons and children's clinical characteristics may have predictive value and provide practice improvement opportunities.

Boston↗

PubMedDate not supplied

Physical performance testing in mucopolysaccharidosis I: a pilot study.

OBJECTIVE: To develop and field-test a physical performance measure (MPS-PPM) for individuals with Mucopolysaccharidosis I (MPS I), a rare genetic disorder. METHODS: Motor performance and endurance items were developed based on literature review, clinician feedback, feasibility, and equipment and training needs. A standardized testing protocol and scoring rules were created. The MPS-PPM includes: Arm Function (7 items), Leg Function (5 items), and Endurance (2 items). Pilot data were collected for 10 subjects (ages 5-29 years). We calculated Spearman's rho correlations between age, severity and summary z-scores on the MPS-PPM. RESULTS: Subjects had variable presentations, as correlations among the three sub-test scores were not significant. Increasing age was related to greater severity in physical performance (r = 0.72, p<0.05) and lower scores on the Leg Function (r = -0.67, p<0.05) and Endurance (r = -0.65, p<0.05) sub-tests. The MPS-PPM was sensitive to detecting physical performance deficits, as six subjects could not complete the full battery of Arm Function items and eight subjects were unable to complete all Leg Function items. Subjects walked more slowly and expended more energy than typically developing peers. CONCLUSIONS: Individuals with MPS I have difficulty with arm and leg function and reduced endurance. The MPS-PPM is a clinically feasible measure that detects limitations in physical performance and may have potential to quantify changes in function following intervention.

Adolescent↗

PubMedDate not supplied

Tracheostomy speaking valves for children: tolerance and clinical benefits.

INTRODUCTION: Use of a tracheostomy speaking valve allows the expiratory flow of air to exit over the vocal folds promoting phonation. The purpose of this retrospective review was to determine: (1) what percentage of trial candidates tolerated a speaking valve; (2) whether candidates achieved phonation with a valve; and (3) which secondary benefits (coughing ability, secretion management, swallowing/feeding and oxygenation) could be clinically observed. METHODS: Twelve cases of children and youth (ages 8 months to 21 years) evaluated for a tracheostomy speaking valve at an inpatient rehabilitation hospital were reviewed. A speech-language pathologist and respiratory therapist evaluated the children for valve tolerance and candidacy for ongoing use. Clinical observations were used to determine phonation ability and to examine potential secondary benefits. RESULTS: All 10 subjects who tolerated the valve achieved phonation. Vocalizations included audible crying, non-specific vocalizations, word approximations, single words and short phrases. Minimal-to-no improvement was noted for coughing, secretion management, swallowing and oxygenation with clinical assessment. DISCUSSION: With supervision and training, speaking valves can enhance communication options for children and youth with tracheostomies and oxygen and ventilator dependence. Physiological and functional secondary benefits were observed but were more difficult to assess.

Adolescent↗

PubMedDate not supplied

Weaning children from mechanical ventilation in a post-acute care setting.

As medical and technological advances have made it possible to prolong the life of children with chronic respiratory failure, children are being referred to post-acute inpatient rehabilitation programmes. In these settings, children can be weaned from their ventilators and receive medical and rehabilitative care in a developmentally supportive environment at a lower financial cost than in an intensive care unit. There is strong evidence that weaning children from mechanical ventilation has beneficial effects on their functionality, ease of care and quality of life. There is, however, little scientific evidence describing how often successful weaning is achieved or the most effective methods. The purpose of this article is to present a consensus report detailing a structured approach to weaning children from mechanical ventilation in a post-acute care setting. This study proposes a Weaning Severity Index and a Weaning Algorithm for use in the assessment and implementation of the weaning process in post-acute rehabilitation. Future clinical studies are needed to validate the suggested approach to ventilator weaning and to determine whether or not the weaning algorithm results in beneficial patient outcomes.

Algorithms↗

PubMedDate not supplied

Outcome rating scales for pediatric head injury.

Intensivists, surgeons, neurologists, and others involved in pediatric intensive care units (PICUs) have an important investment in both short-and long-term outcomes of children and adolescents with head injury who are treated under their care. Outcomes are most often documented by either single- or multiple-item rating scales and are implemented both during and after hospital care. For this review, the authors have organized the content of rating scales into 6 general classes: (1) mortality prediction, (2) severity, (3) global recovery, (4) activity restrictions, (5) secondary adverse conditions, and (6) limitations in participation, quality of life, and health status. Rating scales that describe the outcomes of children and adolescents after head injury are used to monitor medical and functional recovery, guide clinical management, drive quality assurance initiatives, and conduct clinical research. The authors restrict their selective review to rating scales that describe child outcomes (vs family) and that have been reported and applied in the outcome literature. Although head injury is a major cause of mortality and short- and long-term morbidity in children and adolescents, there is no consensus on which rating scales are optimal for hospital care or community follow-up. Major considerations for clinical use are feasibility, type of outcome information needed, content breadth across multiple ages and levels of recovery, and utility in determining the short-term impact of PICU care on long-term outcome.

Activities of Daily Living↗

PubMedDate not supplied

Exploring parents' use of strategies to promote social participation of school-age children with acquired brain injuries.

OBJECTIVE: To understand parents' perspectives about the strategies they use to promote social participation of their school-age children with acquired brain injuries (ABI) in home, school, and community life. METHOD: A descriptive research design employing a semistructured interview format was used. Interviews were conducted in the homes of 16 families of school-age children with ABI discharged up to 7 years earlier from one inpatient rehabilitation program. Data were examined using content and constant-comparison analyses. RESULTS: Parents needed time to allow the recovery process to unfold for themselves and their children and developed strategies that fit into or assisted with managing family routines. Over time parents developed insight into the activity demands and their child's potential success to participate in desired activities. Based on these insights, parents used "anticipatory planning," which involved previewing upcoming events and activities and using strategies to promote positive and prevent negative experiences for their children. Specific strategies that parents used to promote social participation were classified into three categories: Creating opportunities, teaching skills, and regulating cognitive and behavioral function. CONCLUSIONS: Understanding how families use and integrate strategies within the context of their daily lives and what factors influence strategy use may provide practitioners with insights needed to support families in promoting their children's social participation.

Adolescent↗

PubMedDate not supplied

Parental perceptions of oral health-related quality of life for children with special needs: impact of oral rehabilitation under general anesthesia.

PURPOSE: The purposes of this study were to: (1) describe the symptoms, daily life problems and parental concerns related to oral health for children with special health care needs; and (2) examine the effectiveness of oral rehabilitation under general anesthesia at improving quality of life (QOL). METHODS: A single-group design measuring change over time was used. Family caregivers of 107 children with special needs, for whom oral rehabilitation under general anesthesia was recommended, completed a QOL survey upon dental examination. RESULTS: Seventy-three children underwent oral rehabilitation, and 50 completed a follow-up survey. The most frequent survey responses before oral rehabilitation were: (1) spontaneous toothache and pain with hot/cold temperatures (oral symptoms); (2) difficulty eating and sleeping (daily life problems); and (3) worrying about eating and nutrition (parental concerns). Severity ratings for oral symptoms, daily life problems, and parental concerns were significantly lower (P<.001), and scores for oral well-being were significantly higher (P<.001) following oral rehabilitation. CONCLUSIONS: Family caregivers of special health care needs patients report a variety of oral symptoms, daily life problems, and concerns attributable to their child's oral health that impact QOL. Oral rehabilitation under general anesthesia is effective at improving QOL for special health care needs children and their families.

Activities of Daily Living↗