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Aim: To determine caregiver knowledge and preferences for gross motor information and examine differences across Gross Motor Function Classification System (GMFCS) levels., Method: A questionnaire was developed. Respondents reported GMFCS knowledge, preference for knowledge, and experience with GMFCS and motor curve information., Results: In total, 303 caregivers of children with cerebral palsy (CP) (GMFCS level I: 22%; GMFCS level II: 16%; GMFCS level III: 15%; GMFCS level IV: 23%; GMFCS level V: 24%) completed the questionnaire. Forty-five per cent of caregivers knew the GMFCS level at survey, and only 31% knew how their child's motor development compared with others of similar age and level. Caregiver education level was associated with knowledge (p<0.001). Most prefer discussing motor development with a therapist. Of caregivers who knew their child's GMFCS level at survey, 83% reported it would be helpful to revisit the topic over time. Compared with GMFCS level IV and V, caregivers of children in GMFCS levels I to III preferred to learn at the same time as CP diagnosis, (p=0.04) and were more likely to report having received visual aids (p=0.04). Caregivers of children in GMFCS levels IV and V found it more difficult to learn their child's level (p<0.001) versus those caring for children of GMFCS levels I to III, and reported seeing pictures with descriptions more informative (p=0.03)., Interpretation: Caregivers of children with CP may not know GMFCS and motor curve information, and vary in experience and preferences for this information., What This Paper Adds: Fewer than half of caregivers of children with cerebral palsy (CP) know their child's Gross Motor Function Classification System level. Most want to know how their child's function compares to other children with CP. The majority of caregivers would like to revisit the topic over time. Caregivers want to discuss gross motor information with the therapist and doctor., (© 2018 Mac Keith Press.)

Children with acute onset non-traumatic limp often present to emergency departments (EDs). The limp can occasionally be associated with medical emergencies such as septic arthritis and slipped upper femoral epiphysis but is often due to less severe conditions. This article discusses the common and self-limiting causes of acute onset of non-traumatic limp in children, such as transient synovitis, reactive arthritis, and benign acute childhood myositis. It also discusses more severe conditions, including septic arthritis, osteomyelitis, slipped upper femoral epiphysis, Perthes disease, malignancies and non-accidental injury. Management and prognosis of these conditions are discussed in the context of guidance from the National Institute for Health and Care Excellence. The article includes two case studies that illustrate different presentations and the challenges that nurses who manage children in EDs are likely to come across in clinical practice., Competing Interests: None declared, (©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Disruption in the interaction between the central nervous system, nerves, and muscles cause movement disorders. These disorders can negatively affect quality of life. Deep brain stimulation (DBS) has been identified as a therapy for Parkinson disease and essential tremor that has significant advantages compared with medicinal therapies. Surgical intervention for these disorders before DBS included ablative therapies such as thalamotomy and pallidotomy. These procedures were not reversible and did not allow for treatment adjustments. The advent of DBS progressed therapies for significant movement disorders into the realm of being reversible and adjustable based on patient symptoms., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Single neuron actions and interactions are the sine qua non of brain function, and nearly all diseases and injuries of the CNS trace their clinical sequelae to neuronal dysfunction or failure. Remarkably, discussion of neuronal activity is largely absent in clinical neuroscience. Advances in neurotechnology and computational capabilities, accompanied by shifts in theoretical frameworks, have led to renewed interest in the information represented by single neurons. Using direct interfaces with the nervous system, millisecond-scale information will soon be extracted from single neurons in clinical environments, supporting personalized treatment of neurologic and psychiatric disease. In this Perspective, we focus on single-neuronal activity in restoring communication and motor control in patients suffering from devastating neurological injuries. We also explore the single neuron's role in epilepsy and movement disorders, surgical anesthesia, and in cognitive processes disrupted in neurodegenerative and neuropsychiatric disease. Finally, we speculate on how technological advances will revolutionize neurotherapeutics., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: Anxiety-like (ANX) and depression-like (DEP) symptoms are common consequences of traumatic brain injury (TBI). Environmental enrichment (EE) attenuates many deficits, though its impact on ANX and DEP symptoms has yet to be described., Methods: Adult male Long-Evans rats were subject to a medial frontal cortex (mFC) cortical impact injury or sham preparation, then placed into EE or standard housing (SE). ANX symptoms were analyzed using the open field test (OFT) and elevated plus maze (EPM). The forced swim task (FST) and sucrose consumption task (SCT) were used to quantify DEP symptoms. In order to measure changes in spatial learning and motor performance, the Barnes maze (BM) and rotor rod (RR) were utilized., Results: Damage to the mFC resulted in functional losses in motor and cognitive behavior and an increase in ANX and DEP symptoms. Placement of injured rats into the EE improves motor functioning after TBI and resulted in an decreased latency to locate the escape box in the BM. Though the application of an EE attenuated deficits in BM and RR performance, the ANX and DEP behavioral symptoms persisted., Conclusions: Additional therapeutic approaches paired with EE may be necessary to address all functional changes post-TBI. Additionally, no single behavioral assessment appears to clearly identify symptoms of ANX or DEP in rats following TBI, however utilizing multiple tests can be potentially confounding.

A child who limps often presents a diagnostic challenge. The differential diagnosis is extensive. Although the most common cause is trauma, awareness of other potential causes is important. The age of the child and the pattern of the gait help narrow the differential diagnosis. In most cases, a diagnosis can be made from the history and physical examination. If the diagnosis is not obvious after a careful clinical evaluation, plain radiographs provide an excellent means of screening for fracture, joint effusion, lytic lesions, periosteal reaction, and avascular necrosis. Other tests should only be ordered when indicated.

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.

Background: Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long-term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment., Aim: To find whether elderly people with a dementia and a mobility problem show a greater improvement in mobility skills if given physiotherapy treatment than if given non-physical activities intervention during a hospital respite admission., Method: A controlled randomized multicentre trial with independent blinded assessment. The Southampton Mobility Assessment (mobility score) and Two Minute Walking Test (distance walked) were undertaken at the beginning and end of the study admission and beginning of the next respite admission. Following the first assessment, participants were randomized to either physiotherapy or activities., Results: Eighty-one participants, from 12 clinical centres, with a mean age of 81.9 years and CAPE I/O score of 2. During the study admission there was a non-significant trend for a lower reduction in mobility score of the physiotherapy group (Mann-Whitney; p = 0.614) and a non-significant trend for greater decrease in distance walked in the activities group (t-test; p = 0.325)., Discussion: The results of this trial do not support the positive changes demonstrated elsewhere. However, changes in respite care during the early stages of this trial may have produced differences between the sample for this trial and that for the pilot study. This trial was therefore underpowered., Conclusion: This trial suggests that future research needs to change the focus from clinical settings to presentations.

From mobility to disability; this is the plight of the patient with a movement disorder. Alterations in motor functioning may include gait, balance, coordination and tone as well as voluntary and involuntary movements. These changes need to be observed, assessed and monitored, then correlated with the neuropathology and neurochemistry. The nurse, by doing this, provides the physician with the crucial information for successful medical management. This presentation will identify the pathology and required nursing assessment for the more prevalent movement disorders and provide an overview of pharmaceutical management.

The clinical presence of impaired physical mobility documented for acute-care patients was studied. The frequency, individual, and group sensitivity levels of the defining characteristics documented as empirical referents for the diagnosis were examined. The frequency of the related factors associated with the diagnosis, patient demographics, length of stay (LOS), discharge destination, and diagnostic-related groups (DRGs) were also examined. Data were obtained from electronic tapes of patient information. Support was found for impaired mobility, as a high-frequency diagnosis, in heterogeneous acute-care patients. No support was found for any major defining characteristics across the heterogeneous sample. A cluster of three defining characteristics: (a) inability to purposefully move within the environment; (b) decreased muscle strength, control, or mass; and (c) imposed restrictions of movement was supported by group sensitivity measures. Major defining characteristics were supported in two DRG subsets. Clusters of defining characteristics varied among four DRGs. The NANDA-preidentified related factors were associated with the diagnosis. Electronic storage and retrieval of computerized nursing data, including the elements of the Nursing Minimum Data Set (NMDS), was an effective, efficient method for data collection and analysis.

Standardized rating scales for Parkinson's disease and dystonia have been validated and are now widely accepted as useful clinical assessment tools. However, the other movement disorders have been more difficult to quantify. The use of a standardized videotape protocol can provide a more precise audiovisual record of the movement disorder patient. With broader use by others and further revisions, these guidelines can be improved in order to provide an accurate assessment and teaching tool. The authors welcome comments.

The focus of this article is to provide the reader with a greater understanding of acute spinal cord injury from the nursing diagnosis perspective. Nurses have a significant role to play in the acute care phase, which will have an even greater and long-lasting impact on the quality of life for persons with spinal cord injury.

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.

The dyskinesia syndromes are a group of physically, socially and psychologically debilitating diseases. Many patients may be helped through medical management consisting of drugs, physical and speech therapy, and vocational rehabilitation. However, when medical management fails to palliate symptoms, surgical intervention may be the patient's alternative. The ultimate goal of therapy is to lead an improved quality of life. As a neurosurgical nurse, you have an important role in achieving that goal.

The older adult who is critically ill is extremely vulnerable to deficits in sleep and mobility related to (1) the seriousness of his or her pathologic conditions, (2) the physiologic alterations that normally occur with aging, and (3) the unique characteristics of the critical care environment. The challenge to nursing lies in understanding the age-related changes that occur in neuromusculoskeletal function and how these changes may influence an already compromised system. With this knowledge base, alterations in sleep and mobility in the critically ill elder can be accurately assessed and appropriate nursing interventions planned and implemented.