Search

PURPOSE: To explore the perspectives of primary caregivers of children with cerebral palsy (CP) who had spinal surgery for scoliosis. MATERIALS AND METHODS: A qualitative study was conducted using semi-structured interviews and guided by qualitative description methodology. Participants were caregivers of children with CP aged 5-18, who had undergone spinal surgery for scoliosis in Australia. The research team included a parent with lived experience. RESULTS: Fourteen participants (8 biological mothers), aged 40-49 years, completed online semi-structured interviews. Four themes were identified emerged. Life with a child with CP underpinned all experiences which were founded on familiarity with their child, medical procedures, and hospitalisation. Three subthemes were parents are the experts in knowing their child, children are vulnerable, and impact on caregivers. Theme 2 involved the significance of decision making to proceed with surgery. Theme 3 underscored a need to be prepared for the surgical journey and, in Theme 4, participants spoke of needing to expect the unexpected. CONCLUSION: The findings highlight the importance of understanding caregiver experiences and can help inform health professionals and other families in the decision-making process, preparing for and navigating spinal surgery.

PURPOSE: To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy. METHODS: A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5-15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles. RESULTS: The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81-25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20-33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings. CONCLUSION: The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population. Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572 IMPLICATIONS FOR REHABILITATIONThere may be incremental benefit, for children with cerebral palsy, at 6 and 12 months on passive wrist range from wearing a rigid wrist-hand orthosis designed according to this protocol.The rigid-wrist-hand orthosis evaluated in this study, which allowed for some tailoring for individual children's presentations, differed in design from past recommendations for "resting hand" positioning.Longitudina

AIM: To outline the development and examine the content and construct validity of a new tool, the Dyskinetic Cerebral Palsy Functional Impact Scale (D-FIS), which measures the impact of dyskinesia on everyday activities in children with cerebral palsy (CP). METHOD: D-FIS content was informed by a systematic review of dyskinesia outcome measures, in collaboration with children with dyskinetic CP, parents, caregivers, and expert clinicians. The D-FIS uses parent proxy to rate impact of dyskinesia on everyday activities. Construct validity was determined by examining internal consistency; known groups validity with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), and Eating and Drinking Ability Classification System (EDACS); and convergent validity with the Barry-Albright Dystonia Scale (BADS). RESULTS: Fifty-seven parents of children (29 males, 28 females, mean [SD] age 11y 8mo [4y 4mo], range 2y 6mo-18y) completed the D-FIS. Correlation between D-FIS and GMFCS was r=0.86 (95% confidence interval [CI]: 0.77-0.91, p<0.001); MACS r=0.84 (95% CI: 0.73-0.90, p<0.001); CFCS r=0.80 (95% CI: 0.67-0.88, p<0.001); and EDACS r=0.78 (95% CI: 0.66-0.87). Correlation between D-FIS and BADS was r=0.77 (95% CI: 0.64-0.86, p<0.001). Cronbach's alpha was 0.96. INTERPRETATION: The D-FIS demonstrates good construct validity and high internal consistency. The D-FIS will be useful for identifying priorities for intervention. It adds to the measurement tool kit for children with dyskinetic CP by addressing functional impact of dyskinetic movements and postures. What this paper adds The Dyskinetic Cerebral Palsy Functional Impact Scale (D-FIS) assesses the perceived impact of dyskinesia on daily activities in children with cerebral palsy (CP). The D-FIS demonstrates good construct validity and high internal consistency. The D-FIS is a clinically feasible, family-centred tool that fills a

Aim: To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). Method(s): Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). Result(s): From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. Interpretation(s): Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than info

Objective: Rigid wrist-hand orthoses (WHO), used with children with cerebral palsy (CP), aim to maintain soft tissue length, thought to contribute to preserving functional hand use. Past research is limited by small samples and short intervention periods (<6 months). This study investigated effectiveness of long-term provision of rigid WHO combined with usual multidisciplinary care, to reduce hand impairments. Design(s): A pragmatic, prospective, multicentre, assessor-blinded randomised controlled trial with 1:1 allocation to Intervention or control group. Method(s): Eligible participants were aged 5-15 years, diagnosed with CP, presenting with Modified Ashworth Scale score >=1 at the wrist. Sample estimate was 97 per group to detect a 10degree between-group difference in wrist extension at 3 years. Recruitment occurred at five Australian sites. Independent randomisation with concealed allocation was stratified by study site and passive wrist range (3 strata). In bilateral presentations, allocation was by child (both wrists same allocation). Children randomised to the intervention received a custom-made rigid WHO for maintaining length in the flexor compartment of the forearm/hand, to be worn for >=6 hours/ night. The trial stopped early due to insufficient recruitment and resources. The primary outcome was passive wrist extension (fingers extended) at 3 years. Given early cessation, all measures taken 6-monthly were included in repeated measures two-level mixed regression models, to obtain comparisons between groups in accordance with intention-to-treat principles. Result(s): Seventy-four children were randomised (n=38 intervention; n=36 control). Mean age was 10.2 (SD 3.1) years (intervention) and 9.1 (SD 2.8) years (control); n=18 intervention and n=16 control group participants were male. Children in all levels of the Manual Ability Classification System were included. There were 96 included limbs (n=47 intervention; n=49 control). Limbs available for analysis a

AIM: To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). METHOD: Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). RESULTS: From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. INTERPRETATION: Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information

Introduction: Motor outcomes of children with unilateral cerebral palsy (CP) are clearly documented, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Patients and Methods: This was a prospective, cross-sectional multi-centre observational study. A convenience sample of 78 children (46 males, 37 left hemiplegia, mean age 9.0y, SD 1.9y; MACS I [n=24], MACS II [n=54]) with unilateral CP and without intellectual impairment were recruited. We examined associations between cognition, namely executive functions (EF), and bimanual performance. Primary outcomes included: Bimanual performance - the Assisting Hand Assessment (AHA) and Cognition (EF) - information processing (NEPSY - semantics total score); attention control (Test of Everyday Attention for Children (TEA-Ch) - time/target scores); cognitive flexibility (Neuropsychology Assessment for Children-II (NEPSY) - inhibition combined scores); and goal setting (Tower of London - total z-scores). Data were analysed using linear regression models. The model was adjusted for unimanual capacity and general cognitive ability. Result(s): Prior to adjusting for covariates, all 4 domains of EF including information processing (p=0.006), attention control (p=0.015), cognitive flexibility (p=<0.001), and goal setting (p=0.015) significantly impacted bimanual performance (AHA). After adjusting for general cognitive ability and unimanual capacity, only a significant effect for cognitive flexibility on bimanual performance remained (p=0.04). Conclusion(s): This data partially supports our hypothesis that high-level cognitive function (particularly cognitive flexibility) may impact how children with unilateral CP, without intellectual impairment, perform bimanual tasks.

Background and Objective(s): Constraint-induced movement therapy (CIMT) aims to increase spontaneous use of the more affected upper limb and improve unimanual capacity and bimanual performance. We aimed to evaluate the effect of CIMT in children with unilateral CP Study Design: Cochrane Systematic Review. Study Participants & Setting: Not applicable. Materials/Methods: Randomised controlled trials comparing CIMT with a low dose, high dose, dose-matched comparison or a different form of CIMT in children with unilateral CP, aged between 0 and 19 years were eligible for inclusion. In September 2016, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, PsychInfo, EMBASE, Science Citation Index, PEDro, OTseeker, three trial registers and all relevant reference lists. Data extraction and other methods were completed by two independent reviewers - risk of bias was assessed using Cochrane's tool for assessing risk of bias and GRADE was used to rate overall quality of evidence and strength of recommendations Results: We included 34 randomised controlled trials including 1171 participants; mean age 6.23y (SD 1.90), range 7mo-19.8y; 53% male; 47% left hemiplegia. Mean intervention program length was 4 wks, range 1-10 wks. Session frequency ranged from twice weekly to 7 days per wk. Session duration ranged from 0.5-8 hrs. Mean total number of hours of CIMT provided was 129 hrs (range 20-504 hrs). CIMT was delivered by therapists, parents, teachers or other interventionists. Constraint methods included a mitt/glove (n=10) a sling (n=10), splint (n=7), cast (n=6) and bandage (n=1). Fifty-three outcome measures were used across studies. We judged the risk of bias as moderate to high across the studies. Low-quality evidence indicates that CIMT is more effective than a low dose comparison for improving bimanual performance immediately following intervention (Mean difference () 5.44 AHA units, 95% CI 2.37 to 8.51). CIMT was not more effective for

Introduction: Constraint-induced movement therapy (CIMT) aims to improve unimanual capacity and bimanual performance. Material(s) and Method(s): This was a Cochrane systematic review. Randomised controlled trials comparing CIMT with a low dose, high dose, dose-matched comparison or a different form of CIMT in children with unilateral CP, aged 0 to 19 years were included. The search strategy was undertaken in March 2018. Risk of bias was assessed using Cochrane's tool and GRADE used to rate the overall quality of evidence. Result(s): We included 36 randomised controlled trials including 1264 participants; mean age 5.96 years (SD 1.82), range 3 months to 19.8 years; 53% males; 47% left hemiplegia. Mean total number of hours of CIMT provided was 129 hours (range 20-504hrs). We judged the risk of bias as moderate to high across the studies. Low-quality evidence indicates that CIMT is more effective than a low dose comparison for improving bimanual performance immediately following intervention (mean difference [MD] 5.44 AHA units, 95% CI 2.37-8.51). CIMT was not more effective for improving bimanual performance immediately following intervention when compared with high dose (MD -0.39 AHA units, 95% CI -3.14 to 2.36) or dose-matched intervention (MD 0.80 AHA units, 95% CI -0.78 to 2.38). Conclusion(s): For children with unilateral CP, there is low to very low evidence that CIMT results in improved bimanual performance and unimanual capacity when compared to a low dose comparison, but not when compared to a high dose or dose-matched comparison.

Background and Objective(s): Research suggests that specific cognitive functions may be associated with bimanual task performance in children with unilateral cerebral palsy (CP), yet it is unclear whether this is influenced by the neuropathological heterogeneity of this clinical population. We examined whether neuropathology (magnetic resonance imaging (MRI) abnormality classification), and other clinical characteristics mediate the relationship between executive function (EF) and bimanual performance in children with unilateral CP. Study Design: Prospective, cross-sectional multi-centre observational study. Study Participants & Setting: The sample comprised 64 children, including 39 males (61%), aged 6-12 years at recruitment (mean age 9.0y; SD 1.9y), recruited from five Australian paediatric treatment centres between July 2012 and August 2015, with unilateral CP (53% right hemiparesis; CS I (n=16), CS II (n=47), CS III (n=1)). Materials/Methods: The Assisting Hand Assessment (AHA), a standardized, criterion-referenced test of bimanual performance was the primary outcome. MRI were coded using an established protocol and data extracted retrospectively from clinical MRI scans, coded as normal or any of the five predominant pathological patterns: White Matter Injury (WMI), Grey Matter Injury (GMI), Focal Vascular Injury (FVI), malformations and miscellaneous pathologies. Parents completed a global EF questionnaire, and children completed standardised tests of EF (information processing, attention control, cognitive flexibility and goal setting) and intellectual function. The relationship between bimanual performance and the four EF domains, general executive functioning and MRI pathology type were examined using linear regression models Results: Comparisons were between WMI and FVI pathologies. No children had GMI. There were few children with mixed pathologies on MRI (n=3), normal MRI scans (n=2), malformations (n=4) and miscellaneous lesions (n=1); these were exclud

Background: Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks. Methods/Design: This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain - lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive - standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. Discussion(s): This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the devel

© 2018 The Author(s). Background: Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks. Methods/Design: This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain - lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive - standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location. Discussion: This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and

Objectives Congenital hemiplegia is the most common form of cerebral palsy (CP). Children with unilateral CP show signs of upper limb asymmetry by 8 months corrected age (ca) but are frequently not referred to therapy until after 12 months ca. This study compares the efficacy of infant-friendly modified constraint-induced movement therapy (Baby mCIMT) to infant friendly bimanual therapy (Baby BIM) on upper limb, cognitive and neuroplasticity outcomes in a multisite randomised comparison trial. Methods and analysis 150 infants (75 in each group), aged between 3 and 6 months ca, with asymmetric brain injury and clinical signs of upper extremity asymmetry will be recruited. Children will be randomised centrally to receive equal doses of either Baby mCIMT or Baby BIM. Baby mCIMT comprises restraint of the unimpaired hand using a simple restraint (eg, glove, sock), combined with intensive parent implemented practice focusing on active use of the impaired hand in a play-based context. In contrast, Baby BIM promotes active play requiring both hands in a play-based context. Both interventions will be delivered by parents at home with monthly home visits and interim telecommunication support by study therapists. Assessments will be conducted at study entry; at 6, 12 months ca immediately postintervention (primary outcome) and 24 months ca (retention). The primary outcome will be the Mini-Assisting Hand Assessment. Secondary outcomes include the Bayley Scale for Infant and Toddler Development (cognitive and motor domains) and the Hand Assessment of Infants. A subset of children will undertake MRI scans at 24 months ca to evaluate brain lesion severity and brain (re)organisation after intervention. Ethics and dissemination Full ethical approvals for this study have been obtained from the relevant sites. The findings will be disseminated in peer-reviewed publications. Trial registration number Australian and New Zealand Clinical Trials Registry: ACTRN12615000180516, Pre results

Background: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. Methods/design: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score >=1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6h nightly (or daily) to wear for 3years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. Discussion(s): T

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. DISCUSSION: T

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone. METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score =1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed. DISCUSSION: T

Objectives: The Melbourne Assessment of Unilateral Upper Limb Function (MA) was refined and revised using Rasch Analysis and subsequently published as the Melbourne Assessment 2 (MA2) comprising four sub-scales: range of movement; fluency; dexterity and accuracy. This study investigated sensitivity of the MA2 by: 1) estimating standard error of measurement (SEM) for each sub-scale and 2) assessing if sub-scales can detect change in unilateral upper limb abilities of children with cerebral palsy aged 2.5-15 years. Design(s): A 2-phase study employed 1) test-retest and 2) prepost test design methods. Method(s): Data for each phase were collected both prospectively and from two earlier studies involving the original MA. MA scores were converted to MA2 scores prior to analysis. MACS levels were not collected in earlier studies. Phase 1 involved 23 children, mean age 7 years 9 months (SD 3yr 7mo); n=18 males, n=5 females; n=8 MACS level II, n=15 missing. All children completed the MA or MA2 on two occasions (retest period 2-4wk). Four trained raters scored video recordings of 15 children and one trained rater scored the remaining eight children. SEM for each sub-scale raw score was calculated using the mean value of the variability between two assessment occasions. Phase 2 involved 27 children, mean age 4 years 9 months (SD 4yr 0mo); n=19 males, n=8 females; n=14 MACS level II, n=3 MACS level III and n=10 missing. All children received botulinum toxin-A injections with occupational therapy, interventions known to effect change in upper limb function. MA or MA2 data were collected at three time points: pre- and 2 and 4 months post- intervention. Differences in sub-scale raw total scores across time points were assessed using repeated measures ANOVA. Result(s): Preliminary results estimate SEM for each sub-scale total raw score as: Range (total score 29) SEM +/-1.9; Accuracy (total score 25) SEM +/-2.1; Dexterity (total score 14-19) SEM +/-1.0 and Fluency (total score 21)

Background Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination. If decreasing the frequency of changing intravenous administration sets does not increase infection rates, a change in practice could result in considerable cost savings. Objectives The objective of this review was to identify the optimal interval for the routine replacement of intravenous administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered to people in hospital via central or peripheral venous catheters. Search strategy We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE: all from inception to February 2004; reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. We did not have a language restriction. Selection criteria We included all randomized or quasi-randomized controlled trials addressing the frequency of replacing intravenous administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered to people in hospital via a central or peripheral catheter. Data collection and analysis Two authors assessed all potentially relevant studies. We resolved disagreements between the two authors by discussion with a third author. We collected data for the outcomes; infusate contamination; infusate-related bloodstream infection; catheter contamination; catheter-related bloodstream infection; all-cause bloodstream infection and all-cause mortality.

OBJECTIVE: To determine the optimal time interval for the routine replacement of intravenous administration sets when crystalloids or parenteral nutrition are administered via a central or peripheral catheter in an acute care setting. DESIGN: Systematic review of all randomized or systematically allocated controlled trials addressing the frequency of replacing intravenous administration sets. METHODS: The Cochrane Controlled Trials Register (June 2001) and the Ovid databases (Medline, CINAHL, and CancerLit-July 2001) were searched. Bibliographies, relevant conference proceedings, and any product information were also checked for references. RESULTS: Eighteen studies were selected for review. The 12 included studies were separated into 3 intravenous administration set change comparisons: 24 hours versus 48 hours or more; 48 hours versus 72 hours or more; and 72 hours versus 96 hours or more. There was good evidence that changing intravenous administration sets every 72 hours or more does not increase the risk of infusate-related bloodstream infection (BSI) in patients with central or peripheral catheters and a fair level of evidence that it does not increase the risk of catheter-related BSI. There were insufficient data regarding the incidence of BSI among patients receiving parenteral nutrition, particularly lipid-containing parenteral nutrition. CONCLUSIONS: It appears that intravenous administration sets containing crystalloids can be changed in patients with central or peripheral catheters every 72 hours or more without increasing the risk of BSI. However, it is not possible to conclude that intravenous administration sets containing parenteral nutrition, particularly lipid-containing parenteral nutrition, can be changed at this interval.