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This thesis examines several aspects of the debate on the choice of best firstline treatment for infantile spasms. The first part of the thesis describes, analyses and interprets outcomes from the United Kingdom Infantile Spasms Study (UKISS), a multicentre randomised controlled trial that compares treatment with prednisolone or tetracosactide (hormonal treatments) against vigabatrin. This study was coordinated from the Bath Unit for Research in Paediatrics at the Royal United Hospital, Bath, and showed that the early primary clinical response, cessation of spasms, was significantly more likely in infants who were allocated hormonal treatments. However, the overall proportions with relapse-free response at the end of the study period, when the child reached the age of 12 to 14 months, were similar in all three treatment groups. In a group of infants of a priori interest who had no identified underlying aetiology, neurodevelopmental outcomes were significantly better in children who had been allocated hormonal treatments, although this finding was not robust within a sensitivity analysis. The second part of the thesis examines problems with case definitions and outcome measures in epidemiological and interventional studies of infantile spasms, and describes the development of West Delphi, a consensus elicitation process that has produced published proposals for standardised case definitions and outcome measures for such studies. Its most novel proposals were: (1) that the primary clinical outcome cessation of spasms should be defined by the absence of observed spasms for at least 28 days from the time of the last observed spasms, with the last spasms being observed within 14 days of treatment allocation; and (2) that there should be a standardised primary electroclinical response that studies should also report as a primary outcome.

An approach based on the estimation of the coherence using wavelet analysis is applied to EEG and ERP signals for the detection of pathological patterns related with dyslexia. Coherence can be defined as the correlation of two signals in the frequency domain. The continuous wavelet transform was used for the computation of spectral characteristics since it provides highly overlapping windows which improve the reliability of the coherence estimate. This is achieved by increasing the number of segments over which the spectrum is averaged and thereby half of the amount of data is needed. Statistical analysis of the results revealed significant differences between controls and dyslexics in EEG(F3 gamma band), ERP-P50H(F3 gamma band) and attentive ERP-N100L(F3, C3 and Cz alpha band). It has also been shown that there are significant differences related with handiness and age. It is believed that signal recording from these electrodes may reflect brain areas concerning auditory and memory processing. / -

Providing adequate nutrition to children with severe neurological disabilities is extremely difficult due to the high prevalence of oral-motor dysfunction in this group. Short stature and light weight for height are common in disabled children and undernutrition is believed to play a role in this poor growth. This programme of study investigated the effect of gastrostomy-tube feeding in disabled children with oral-motor dysfunction and evaluated the energy balance and body composition of disabled children fed both orally and via gastrostomy-tube over twelve months. The Quality of Life of the children and their carers was also evaluated. Energy intake was measured using three-day dietary diaries and energy expenditure with indirect calorimetry and doubly labelled water. Total body water using oxygen-18 dilution was used to evaluate body composition along with standard anthropometry. Improved growth, nutritional status and general health were seen at six and twelve months after gastrostomy-tube placement. The Quality of Life of the children and their carers also significantly increased. Both energy intake and energy expenditure were found to be lower than reference standards, but energy balance was positive indicating that inadequate nutrition was not the sole cause of poor growth. Body composition was also found to be significantly different from reference. Fat-free mass was significantly low for age and for height. Fat mass was higher in gastrostomy-tube fed children, but lower or normal in disabled children fed orally. Physical activity levels were low for the entire group of disabled children yet the gastrostomy-tube fed children displayed much higher levels of disability. Gastrostomy-tube feeding has a positive impact upon the growth, health and Quality of Life of disabled children and their carers. Careful follow-up is critical in order to optimize health and body composition.

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Dissertation / The sensory integration approach originates from physical (anatomical and physiological) evidence whilst the play therapy approach originates from psychological evidence. Apart from play therapy, the researcher has also attended various courses in sensory integration therapy. Although both of these approaches are used as intervention methods with children who display behavioural, emotional and social difficulties, the researcher considered whether it was important for a play therapist to be aware of sensory integration therapy. The researcher then started this study in order to investigate the incidence of sensory integration dysfunction in children who receive play therapy. After completing the study, the researcher is of opinion that it is indeed necessary for play therapists to be aware of sensory integration theory in order to provide holistic play therapy intervention and to ensure positive therapy outcomes. / Social Work / M.Diac. (Play Therapy)