Search

SUMMARY The authors studied the psychological aspects for parents of caring for a young adult with severe phyacal disabilities. Mothers reported significantly more caregiving stress than fathers; a major factor was the persistent limitations in their personal life opportunities and choices at a time when most parents experience freedom from caregiving responsibilities. Contrary to the assumptions of health-care professionals, the parents indicated that they were more anxious than depressed about thkir future options and their childs quality of care and future living circumstances. There was no mbjor psychopathology and a review of high scores on the scale of Psychoticism and Paranoia indicated that the parents responses were a reflection of realistic isolation and lack of trust in professional and agency-based relationships. RESUME Parents de jeunes adultes presentant de graves incapacites: consequences psychologiques de soins a donner Les auteurs ont etudie le retentissement psychologique sur les parents, de soins a donner a de jeunes adultes presentant de graves incapacites. Les meres faisaient part de plus d'angoisse de soins que les peres; un facteur majeur etait une limitation prolongee des opportunites et des choix de la vie personnelle, a un moment ou la plupart des parents beneficient de liberte vis a vis des prises en charge de soins. Contrairement aux affirmations des professionnels de sante, les parents faisaient part de plus d'anxiete que de depression sur leurs options futures, la qualite des soins a donner a leur enfant et les circonstances futures de vie. II ne fut pas constate de psychopathologie et l'analyse des scores elvees aux echelles de tendance psychotiques ou paranoia, montra que les reponses des parents tenaient a une reflexion sur leur isolement et un manque de confiance dans les relations avec professionnels ou associations. ZUSAMMENFASSUNG Eltern junger Erwachsener mit schweren korperlichen Behinderungen: psychologische Folgen fur die Pflegenden Die Autoren untersuchten die psychologischen Folgen fur Eltern, die fur junge Erwachsene mit schweren korperlichen Behinderungen sorgen musten. Die Mutter klagten signifikant haufiger uber Pflegebelastungen als die Vater; der Hauptfaktor bestand in den andauernden Einschrankungen der Gelegenheiten und Moglichkeiten ihres personlichen Lebens zu einem Zeitpunkt, wenn die meisten Eltern ihre Kinder nicht mehr versorgen mussen. Im Gegensatz zu den Vermutungen der Gesundheitsfursorger gaben die Eltern an, das sie mehr besorgt als deprimiert ihren Zukunftsaussichten und der Pflegequalitat und den zukunftigen Lebensbedingungen fur ihre Kinder entgegensahen. Es konnte keine Psychopathologie nachgewiesen werden und die hohen Scores auf den Skalen von Psychotocism und Paranoia zeigten, das die Antworten der Eltern die tatsachliche lsolation und ein mangelhaftes Vertrauen zu professionellen Einrichtungen widerspiegelten. RESUMEN Padres de jovenes adultos con dishabilidades fisicas: caracteristicas psiguicas de sus cuidadores Los autores estudian los aspectos psicologicos de los padres que se cuidan de un joven adulto con discapacidad fisica. Las madres mencionaron sufrir un stress mayor en relacion con los cuidados que los padres, siendo un factor mayor las limitaciones persistentes en las oportunidades de su vida personal y posibilidades de eleccion, en una epoca en que la mayoria de los padres tienen una mayor libertad en las tareas cuidadoras. Contrariamente a lo asumido por cuidadores profesionales, los padres indicaron que estaban mas ansiosos que deprimidos acerca de sus opciones futuras, de la cualidad de los cuidados para sus hijos y de las circunstancias de vida futuras. No habia una psicopatologia mayor y una revision de los puntajes altos en las escales de Psicotocismo y Paranoia indico que las respuestas de los padres eran un reflejo de un aislamiento. realistico y de una falta de confianza en las relaciones profesionales y en las basadas en agencias.

SUMMARY Ten orthopedic surgeons and 10 physical therapists working with spastic cerebral-palsied children were interviewed about the evaluation process they used to assess surgical lengthening of the achilles tendon. Objective and subjective considerations were described and wide variations in responses were found. No single evaluation criterion or subjective factor was mentioned by the majority of either group. In addition, the extent of interprofessional collaboration in presurgical assessment was described. lhose respondents who consulted with other health professionals closely agreed about the purpose of the consultation. It is concluded clinicians need to identify more precisely the essential components of the evaluation process for this type of surgery. RESUME Procedes d'evaluation utilises par les medecins et les kinesitherapeutes dans l'evalutaion de l'allongement du rendon d'Achille chez l'enfant IMC Dix chirurgiens orthopedistes et 10 kinesitherapeutes travaillant avec des enfants IMC spastiques ont ete interroges au sujet de la methode d'evaluation qu'ils utilisaient pour apprecier l'allongement chirurgical du tendon d'Achille. Des considerations objectives et subjectives ont ete decrites et de grandes variations dans les reponses ont ete trouvees. Aucun critere unique d'evaluation ni de facteur subjectif n'ont ete mentionnes par la majorite de l'un ou l'autre groupe. De plus, l'importance de la collaboration inter-professionnelle dans l'evaluation pre-chirurgicale a ete decrite. Les repondants qui s'etaient entretenus avec d'autres professionnels de santeetaient etroitement en accord avec le but de la consultation. En conclusion, les cliniciens doivent identifier avec plus de precision les composants essentiels d'une methode d'evaluation. ZUSAMMENFASSUNG Welche Krirerien werden von Arzten und Bewegungstherapeuren angewandt, um hei einem Kind mit Cerehralparese die Achillessehnenverlangerung zu empfehlen 10 orthopadische Chirurgen und 10 Bewegungstherapeuten, die Kinder mit spastischer Cerebralparese betreuen, wurden uber die Beurteilungskriterien befragt, die sie fur die Entscheidung einer chirurgischen Achillessehnenverlangerung anwenden. Es wurden objektive und subjektive Betrachtungen geschildert und die Antworten enthielten grose Variationsbreiten. Nicht ein Beurteilungskriterium oder subjektiver Faktor wurde von der Mehrzahl von einer der beiden Gruppen genannt. Auβerdem wurde die interdisziplinare Zusammenarbeit bei der prachirurgischen Beurteilung beschrieben. Diejenigen, die sich mit anderen berieten, stimmten uber den Sinn dieser Beratung uberein. Zusammenfassend muβ gesagt werden, daβ die Kliniker die essentiellen Komponenten der Beurteilung genauer herausarbeiten mussen. RESUMEN Proceso de evaluacion utilizado por los medicos y fisioterapeuras para evaluar la elongacion del tendon de Aquiles en el nino con paralisis cerebral Diez cirujanos ortopedicos y 10 fisioteraprutas que trabajaban con ninos con paralibis cerebral espastica fueron entrevistdos acerca del proceso de evaluacion utilizado para evaluar el alargamiento quirurgico del tendon de Aquiles. Se describieron consideraciones objetivas y subjetivas y se hallo una amplia variedad de respuestas. La mayoria de ambos grupos no menciono ningun criterio unico de evaluacion ni ningun valor subjetivo. Los interrogados que consultaban con otros profesionales de la salud estaban de acuerdo acerca del proposito de la consulta. En conclusion, los clinicos necesitan identificar con mayor precision los componentes esenciales del proceso de evaluacion.

UMMARY The lateral equilibrium reaction in stance was assessed in 80 normally developing children aged from nine months to five years. A scoring system and checklist were devised to describe the character and presence of the reaction. The earliest non-functional response was seen at nine months of age, and no functional response was observed to both sides until after two years of age. A progressive increase in functional response to both directions of tilt occurred between 12 and 18 months, with an unexpected drop at 21 and 24 months. All three-year-old and five-year-old children demonstrated a functional response to both sides. The lower extremity pattern was the most consistent component observed in those with a functional response. Individual variations in movements of the trunk, upper extremities and head excluded any indication of developmental patterns for these body segments. The clinical implications of these results are discussed. RESUME Developpement de la reaction d'equilibre laterale en position debout La reaction d'equilibre lateral en position debout a ete appreciee chez 80 enfants au developpement normal, âges de neuf mois a cinq ans. Un systeme de notation de controle des items a ete etabli pour preciser le caractere et la presence de la reaction. La reponse non-fonctionnelle la plus precoce a ete observee a l'âge de neuf mois, et aucune reaction fonctionnelle sur l'un ou l'autre cote n'a ete observee avant l'âge de deux ans. Une apparition progressive de reponses fonctionnelles aux deux directions de poussee est survenue entre 12 et 18 mois, avec une chute inexpliquee a 21 et 24 mois. Tous les enfants de trois et cinq ans presentaient une reponse bilaterale fonctionnelle. La disposition de l'extremite inferieure a ete la composante la plus constante en cas de reponse fonctionnelle. Des variations individuelles dans les mouvements du tronc, des extremites superieures et de la tete excluaient toute indication de disposition developpementale pour ces segments corporels. Les implications cliniques de ces resultats sont discutees. ZUSAMMENFASSUNG Entwicklung der lateralen Gleichgewichtsreaktion in der Korperhaltung Bei 80 sich normal entwickelnden Kindern im Alter zwischen neun Monaten und funf Jahren wurde die laterale Gleichgewichtsreaktion in der Korperhaltung untersucht. Es wurden ein Scoring System und eine Checkliste erstellt, um den Charakter und das Aufreten der Reaktion zu beschrieben. Die fruheste nicht funktionelle Reaktion wurde mit neun Monaten gesehen und keine funktionelle Reaktion zu beiden Seite wurde bis nach dem zweiten Lebensjahr beobachtet. Zwischen dem 12ten und 18ten Monat machte die funktionelle Reaktion zu beiden Neigungsrichtungen einen merklichen Entwicklungsfortschritt, gefolgt von einem unerwarteten Abfall mit 21 und 24 Monaten. Alle drei-und funfjahrigen Kinder zeigten funktionelle Reaktionen zu beiden Seiten. Das Haltungsmuster der unteren Extremitat war die bestandigste Komponente, die bei den Kindern mit einer funktionellen Reaktion beobachtet wurde. Individuelle Unterschiede in der Bewegung vom Rumpf, der oberen Extremitaten und des Kopfes schlos jede Deutung von Entwicklungsmustern fur diese Korperteile aus. Die klinische Bedeutung dieser Ergebnisse wird diskutiert. RESUMEN Desarrollo de la reaccion lateral de equilibrio en posicion saque Se evaluo la reaccion lateral de equilibrio en posicion saque en 18 ninos de desarrollo normal, de nueve meses a cinco anos de edad. Se estructuro un sistema de puntaje y una lista de pruebas para describir el caracter y la presencia de la reaccion. La respuesta no funcional mas precoz se vio a los nueve meses de edad y no se observo respuesta no funcional en ambos lados hasta despues de los anos de edad. Un aumento progresivo en la respuesta funcional para ambas direcciones de inclinacion tuvo lugar entre los 12 y 18 meses con una caida inesperada a los 21 y 24 meses. Todos los ninos de tres y de cinco anos mostraron una respuesta funcional para ambos lados. El componente de extremidad inferior era el mas consistente en los ninos con respuesta funcional. Las variaciones individuales en los movimientos del tronco, extremidades superiores y cabeza excluyen cualquier indicacion de esquemas de desarrollo para estos segmentos corporales. Se discuten implicaciones clinicas de estos resultados.

There has been considerable speculation about the inevitability of parental dissatisfaction with being informed about their child's disability. Mothers and fathers of 24 infants with a recently diagnosed disability were interviewed regarding their preferences for how to be told the "bad news." Qualitative analyses revealed nine themes of parental preferences for how to communicate difficult information. Parents affirmed communication themes previously discussed in the literature, such as being told early and together, and identified new ones, such as affective tone and physical contact with their baby. The importance of these themes is presented for this sample. Recommendations for how to present "bad news" can be concisely drawn from these findings. Results suggest that parental dissatisfaction with the process of telling is not inevitable.

The pediatrician treating a child with a disability must focus not only on the physical needs of the child but also on the emotional and social issues associated with being disabled in our society. This dual focus becomes increasingly important as the child matures through adolescence and transitions into adulthood. In addition, the pediatrician must understand the complex interrelationships between the family and their maturing, disabled child during the vital process of separation from the family. This transition is particularly difficult for an adolescent who is dependent on others for physical care and other independent living skills. Many of the transitional problems faced by disabled adolescents and their parents have roots in early childhood. With an awareness of the specific stressors on the parent caregivers and an understanding of the influence of disability on the developmental processes, the pediatrician can play a major role in easing the transition of a disabled adolescent into adulthood. By guiding the parents of a young child through the important tasks of childhood and adolescence, the pediatrician can set the stage for both the parents and their disabled child to have independent, yet supportive lives--lives that are focused not on the disability but on mutual respect and life satisfaction. It is recommended that disabled teens and young adults be given more help in independence skills, personal counseling services should be made available, and physicians should give teens age-appropriate information about disabilities. There are needs for sex education, preparation for parenthood, and genetic counseling. Other issues that should be addressed are early vocational awareness, alternatives to work, and leisure time use. Just because an adolescent is disabled, we cannot assume that he or she will have self-esteem and self-concept difficulties. To adjust to being devalued by society, the disabled person must challenge societal beliefs that strength, independence, and appearance are the essential aspects of a quality life. The importance of being kind, intelligent, and productive to one's capacity must become more important. (See Table 3 for additional resource information.)

The purpose of this study was to determine which of three durations of a passive stretch was most effective in increasing hip abduction range of motion (ROM) in human subjects. Seventy-two men were randomly assigned into a control group and three passive stretch groups (15 seconds, 45 seconds, and 2 minutes). The two measurements used to determine hip abduction flexibility were abduction ROM and resistance to abduction force. Each subject was measured before and immediately following the passive stretch to determine changes in abduction ROM and resistance to abduction force due to a passive stretch. The results of this study indicated that hip abduction ROM was significantly increased and resistance to hip abduction force was significantly decreased after a passive stretch for all three stretch groups. There was no significant difference between mean differences of abduction ROM of the three stretch groups, except for the comparison of the 15 second and the 45 second stretch groups. The results of the force data demonstrated no significant difference between the mean differences of the three stretch groups. The fact that our data shows 15 seconds is just as effective as stretching for 2 minutes makes it reasonable to stretch for 15 seconds in athletic settings where immediate increases in abduction ROM are desired. J Orthop Sports Phys Ther 1987;8(8):409-416.

The effect of approximation on the postural sway of healthy subjects wearing a weighted belt around their pelvis was measured. Twenty subjects between the ages of 23 and 30 years stood on a polyurethane foam platform that amplified their postural sway and were filmed from a lateral view. All subjects wore markers over their mandibles, hips, and knees and were filmed three times with the weighted belt worn on a randomly selected trial. Frames from a 10-second interval of film from each trial were studied, and the summed displacement at each bony landmark between each frame of film was calculated. A significant decrease in displacement at the mandible (p less than .02) was found when the weighted belt was worn. The decrease in displacement was not significant at the hip or knee. Approximation was shown to decrease the postural sway of healthy subjects. Further study is indicated to investigate the effect of approximation on patient populations.

Biofeedback used selectively can be a valuable adjunct to a physical therapy program. Biofeedback systems can be electronically sophisticated and can report immediate changes in the body such as muscle electrical activity, respiration, blood pressure, and heart rate. Less complex feedback systems have been designed to indicate limb loading pressures,* heel contact during gait, and head position in space.†,‡ Other effective, yet electronically simple, inexpensive feedback systems can be constructed easily by the inexperienced person. These simple feedback systems can be used to reinforce desired behaviors such as head or trunk position and heel contact at initial stance or to encourage active movement in the severely developmentally disabled person. The systems can also be used to remind a patient not to bear weight or load a certain structure, move a joint too much, or sit in a harmful posture.

To the Editor: In response to my Journal article entitled “How to Build Simple Inexpensive Biofeedback Systems: Suggestion from the Field” (August 1984), I received a letter from Gary DeBaucher, Assistant Professor of Rehabilitation Medicine at Emory University. He suggested that the mercury switch I recommend in my article is breakable and should be encapsulated in some manner. His point is well taken. In the 15 or more years I have used the switch, I have never had one break or a child bite on one, but it is possible. I generally cover the switch with duct tape to prevent damage, but Dr. DeBaucher has a very clever suggestion for those of us with minimal supplies—imbed the switch into the cap of a ball-point pen top and pot it in with epoxy or silicone rubber to cover the switch. (I'd make sure the pen top is not potentially injurious to the child.)… [ ARTICLE][1] [1]: /lookup/volpage/64/1235?iss=8

One of the most frustrating problems when working with the severely disabled, profoundly retarded young child is evoking head lifting in the prone position, a movement pattern essential for initiating movement from that position. Many techniques are used by physical therapists to facilitate head lifting, but too often, the child responds only during the brief period of handling. The therapist's challenge is finding an adequate reinforcer to entice the child to lift the head outside the therapy session. Behavior modification techniques have proved helpful in training children to perform specific gross motor tasks.1,2 The focus of behavior modification is to change the behavior of the child within his natural setting by emphasizing not his deficiencies, but the behaviors that are suitable to the environment in which the child lives.3…

The purpose of this study was to determine trends in the changes of the popliteal angle in 130 normal infants between one day and 12 months of age, for use in assessing infants with possible neuromuscular pathology. Using a 360 degree goniometer, the popliteal angle was measured with the hip held at 90 degree flexion, to indicate hamstring-muscle tightness. Limitation of knee extension was also measured with the hip extended (HEKE angle) to indicate capsular tightness. Both the popliteal and HEKE angle measurements showed greatest limitation of knee extension at birth, which decreased until eight months of age, when most infants showed no limitation. A highly significant negative correlation was found between age and mean popliteal and HEKE angles.

The means and standard deviations were obtained for hip extension limitation, internal rotation, external rotation and abduction at nine, 12, 18 and 24 months of age from a sample of 86 normal, healthy children. Statistically significant changes were found for three of the four motions tested. Hip extension limitation decreased from 10 degrees at nine months to 3 degrees at 24 months. At nine months external rotation was greater than internal rotation in all cases, but with increasing age the mean values for the two motions began to approximate each other. There was a statistically significant positive correlation between infants with the greatest hip extension limitation and the degree of external rotation. There was also a significant negative correlation between the least hip extension limitation and greater abduction.