This dissertation aimed to investigate the relationship between posture and reaching in both healthy and pathological conditions, approaching the trunk as a multi-segmented structure. For this purpose, neuromuscular and kinematic profiles were recorded from trunk and arm during seated reaches providing mid-rib vs pelvic levels of trunk support. Healthy adults with mature postural and reaching abilities displayed invariant arm kinematics during the reach. However, participants displayed increased anticipatory control and earlier activation of cervical muscles with mid-rib support. Participants also presented increased compensatory responses of paraspinal muscles when responding to the increased trunk balance demands with pelvic support. Children with moderate/severe cerebral palsy (CP) cannot maintain an upright sitting position and thus cannot create a stable postural frame around which upper limb movements are planned and executed. A second set of studies examined postural and reaching characteristics in these children, while applying axillae, mid-rib or pelvic levels of support. Participants were classified according to their intrinsic level of trunk control as mild, moderate and severe. With higher levels of support children with moderate to severe impairments in trunk control showed improvements of head and trunk control along with enhanced reaching performance. Participants with mild trunk dysfunction were able to sit independently and thus did not demonstrate significant changes in postural and reaching proficiency across levels of external trunk support. Electromyographic profiles were more variable depending on the severity of intrinsic trunk control. Overall, participants in the mild group presented more refined timing mechanisms for both anticipatory (closer to reaching onset) and compensatory (reduced latency) postural adjustments during the reach across all levels of support. Participants in the moderate group displayed earlier muscle onsets and more efficient arm/trunk muscle amplitudes with higher levels of support. Participants in the severe group showed very limited capability of anticipatory control of paraspinal muscles, delayed muscle onsets and variable muscle amplitudes across levels of support. These results emphasize the complex neuro-anatomical nature of trunk control during reaching. Also, they highlight that inefficient postural control while sitting significantly impacts children with CP and trunk dysfunction. This dissertation includes previously unpublished co-authored material.

This dissertation aimed to investigate the relationship between posture and reaching in both healthy and pathological conditions, approaching the trunk as a multi-segmented structure. For this purpose, neuromuscular and kinematic profiles were recorded from trunk and arm during seated reaches providing mid-rib vs pelvic levels of trunk support. Healthy adults with mature postural and reaching abilities displayed invariant arm kinematics during the reach. However, participants displayed increased anticipatory control and earlier activation of cervical muscles with mid-rib support. Participants also presented increased compensatory responses of paraspinal muscles when responding to the increased trunk balance demands with pelvic support. Children with moderate/severe cerebral palsy (CP) cannot maintain an upright sitting position and thus cannot create a stable postural frame around which upper limb movements are planned and executed. A second set of studies examined postural and reaching characteristics in these children, while applying axillae, mid-rib or pelvic levels of support. Participants were classified according to their intrinsic level of trunk control as mild, moderate and severe. With higher levels of support children with moderate to severe impairments in trunk control showed improvements of head and trunk control along with enhanced reaching performance. Participants with mild trunk dysfunction were able to sit independently and thus did not demonstrate significant changes in postural and reaching proficiency across levels of external trunk support. Electromyographic profiles were more variable depending on the severity of intrinsic trunk control. Overall, participants in the mild group presented more refined timing mechanisms for both anticipatory (closer to reaching onset) and compensatory (reduced latency) postural adjustments during the reach across all levels of support. Participants in the moderate group displayed earlier muscle onsets and more efficient arm/trunk muscle amplitudes with higher levels of support. Participants in the severe group showed very limited capability of anticipatory control of paraspinal muscles, delayed muscle onsets and variable muscle amplitudes across levels of support. These results emphasize the complex neuro-anatomical nature of trunk control during reaching. Also, they highlight that inefficient postural control while sitting significantly impacts children with CP and trunk dysfunction. This dissertation includes previously unpublished co-authored material.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A paralisia cerebral à uma patologia crÃnica, irreversÃvel, nÃo progressiva, que ocorre durante o desenvolvimento fetal do cÃrebro, ocasionando alteraÃÃes sensÃrio-motoras que limitam o desempenho da crianÃa na realizaÃÃo das atividades de vida diÃria. Essas alteraÃÃes afetam a crianÃa, e refletem diretamente na qualidade de vida da famÃlia envolvida. O momento do diagnÃstico de paralisia cerebral à rodeada de muita dor, medo e incertezas. Ao considerar esse contexto, mais atenÃÃo deve ser dada à mÃe, pois, à ela a detentora dos cuidados domÃsticos e dos filhos. Assim posto, esse estudo tem como objetivo analisar na percepÃÃo das mÃes, a incerteza na doenÃa de seus filhos com paralisia cerebral com base nos pressupostos da Teoria da Incerteza na DoenÃa, de Mishel. Esta teoria trata das incertezas, anseios e dÃvidas, provocando estresse por parte de quem sofre, por nÃo saber o que pode lhe acontecer no futuro. Trata-se de um estudo descritivo na perspectiva da investigaÃÃo qualitativa, realizado no NÃcleo de Tratamento e EstimulaÃÃo Precoce â NUTEP e no Hospital Infantil Albert Sabin durante os meses de julho e agosto de 2009. Participaram do mesmo 12 mÃes de crianÃas com o diagnÃstico de paralisia cerebral atendidas nos serviÃos supracitados. Os instrumentos para a coleta dos dados foram um formulÃrio com contemplando as variÃveis sociodemogrÃficas das mÃes e um roteiro de entrevista semi-estruturado, composto de dados relacionados à Teoria de Mishel na versÃo pais/ filhos. Os dados foram analisados por meio da AnÃlise de ConteÃdo proposta por Bardin. Nos achados desvelou-se doze categorias temÃticas, a saber: o conhecimento da mÃe sobre o diagnÃstico do filho, bem como sobre a gravidade da doenÃa, momento do diagnÃstico e suas implicaÃÃes futuras, planos para o futuro, ajuda nos cuidados ao filho, melhoria com o tratamento e medicaÃÃes, recebimento de explicaÃÃes sobre a doenÃa, conhecimento sobre o propÃsito dos profissionais, presenÃa de dÃvidas, previsÃes e alteraÃÃes no quadro de saÃde do filho. Diante dos discursos, constatamos que as mÃes apresentam ainda muitos sentimentos de incerteza quanto à patologia da crianÃa, principalmente em relaÃÃo ao futuro. Tais incertezas podem vir a ser reduzidas mediante o apoio dos profissionais de saÃde, oportunizando um melhor manejo com as mÃes, tirando suas dÃvidas, dando explicaÃÃes sobre a patologia e todo o processo de tratamento e, ainda, oferecendo oportunidade para um feedback quanto à evoluÃÃo da crianÃa. Estes aspectos servirÃo como ferramenta para reduzir suas dÃvidas e, conseqÃentemente, suas incertezas. O estudo à mais uma contribuiÃÃo do saber no cenÃrio da enfermagem neurolÃgica, visto que se ancora nas questÃes da promoÃÃo da saÃde visando a melhoria da qualidade de vida destas crianÃas e de seus familiares. / Cerebral palsy is a cronic, irreversible, non-progressive patology that occurs during the fetal development of the brain, provoking motor-sensorial changes which limit the development of a child when accomplishing daily tasks. These changes affect not only the childâs life quality, but also the whole family envolved. The moment a child is diagnosed as having brain paralysis is a painful one and is always surrounded by fear and uncertainties. Considering this context, greater attention should be devoted to the mother since, sheâs the one who is responsible for childcare and household tasks. Therefore, this study has as a main goal, to analyse, from the motherâs perception, the uncertainty in her brain paralysis affected child, based on Uncertainty During Desease Theory, of Mishel. Such theory deals with the uncertainties, anxiety and questionings, provoking stress in those envolved, since they donât know about their childâs future. It is a descriptive study, based on a qualitative, investigative perspective, accomplished at the NÃcleo de Tratamento e EstimulaÃÃo Precoce â NUTEP and at the childrenâs hospital Albert Sabin between July and August 2009.Twelve mothers took part in the study about brain paralysis affected children who were under care in the services mentioned above. The gathering of data was made through forms filled with social and demographics information about the mothers and also through a semi-structured interview composed by data related to Mishelâs Theory according to a parents/children version. Data was analysed based on the Content Analysis proposed by Bardin. Among the studies, twelve thematic categories have been highlighted as follows: The awereness of the mother about her childâs diagnosis as well as its severity, the moment of the diagnosis and its future implications, future plans, help during childcare, improvemnt of explanation about the illness, knowledge about the professionalâs proposes, presence of questionings, previews and changes in the chidâs health situation. During the research we have noticed that the mothers lack information and show feelings of uncertainty about their childrenâs patology, mainly about the future. Such uncertainties may be reduced by the professionals of health, promoting a better relationship with the mothers, clarifying their questions, as well as aquiring information about the patology and all the process of treatment and even giving opportunities for a feedback about the childâs evolution. These aspects will work as a tool to reduce their questions and, consequently their uncertainties. The study is a contribution of knowing in the scene of the neurological nursing, since anchored in the questions of the promotion of the health aiming the improvement of the quality of life of these children and his family.

Esta pesquisa teve como objetivo estudar as condiÃÃes clÃnicas de crianÃas com paralisia cerebral em um serviÃo de referÃncia em atendimento pediÃtrico no municÃpio de Fortaleza, bem como identificar os principais fatores de risco para a paralisia cerebral, determinar suas repercussÃes e o grau de comprometimento no desenvolvimento normal da populaÃÃo estudada, estabelecer o tempo mÃdio decorrido entre a percepÃÃo das alteraÃÃes do desenvolvimento pela famÃlia, o diagnÃstico e encaminhamento mÃdico e admissÃo da crianÃa no serviÃo. Trata-se de um estudo transversal descritivo, realizado no NÃcleo de AtenÃÃo MÃdico Integrada (NAMI) da Universidade de Fortaleza (UNIFOR), no perÃodo de fevereiro a junho de 2005, onde foram avaliadas 85 crianÃas com diagnÃstico definitivo de Paralisia Cerebral (PC), na faixa etÃria de zero a doze anos, com alteraÃÃes sensÃrio-motoras em tÃnus, postura e movimento, dÃficits visuais e auditivos. Os dados coletados foram arquivados em base eletrÃnica EPI-INFO versÃo 6.01 e mostraram os seguintes resultados: a amostra foi constituÃda por 50,6% de crianÃas do sexo masculino, sendo a mÃdia de idade de 4 anos e 3 meses, 85,9% foram procedentes de Fortaleza com mÃdia de idade ao diagnÃstico de PC de 11 meses. Houve um grande percentual de crianÃas que sofreram complicaÃÃes neonatais (77,4%), tendo o desconforto respiratÃrio destacado-se fazendo com que 65,3% recebessem cuidados em UTI neonatal. A maioria das crianÃas apresentou PC do tipo espÃstica (69,1%), de grau severo (51,8%), tetraplÃgicas (71,4%), apenas 27% comunicavam-se verbalmente e 53% freqÃentavam a escola regularmente. Pode-se concluir que a maioria das crianÃas apresenta grave comprometimento sensÃrio-motor e que os primeiros sinais de tal comprometimento foram percebidos por seus familiares, apesar da grande maioria ter recebido atendimento pediÃtrico de rotina no 1Â ano de vida, poucas foram avaliadas e receberam algum tipo de orientaÃÃo sobre o desenvolvimento neuropsicomotor durante as consultas, fato esse que nos alerta sobre a necessidade de realizaÃÃo de conscientizaÃÃo junto a profissionais da atenÃÃo bÃsica para importÃncia da avaliaÃÃo periÃdica do desenvolvimento no 1Â ano de vida, para que se possa assim identificar e encaminhar crianÃas com possÃveis atrasos e patologias graves como a PC em tempo cada vez mais hÃbil, aumentando a probabilidade de uma melhor qualidade de vida. / This research aimed to study the clinical conditions of children with cerebral palsy in a reference service in pediatric care in Fortaleza as well as identify the main risk factors for cerebral palsy, to determine its impact and the degree of impairment in normal development the study population, establish the average time elapsed between the perception of changes in the family development, diagnosis and medical referral and admission of the child in the service. This is a cross sectional study, conducted at the Center for Integrated Medical Care (NAMI), University of Fortaleza (UNIFOR) in the period from February to June 2005, evaluating 85 children with definite diagnosis of cerebral palsy (CP) in aged zero to twelve years, with changes in sensory-motor tone, posture and movement, visual and hearing deficits. The collected data were stored on base Electronic EPI-INFO version 6.01 and the following results: the sample comprised 50.6% of male children, with a mean age of 4 years and 3 months, 85.9% were coming from Fortaleza mean age at CP diagnosis of 11 months. There was a large percentage of children who suffered neonatal complications (77.4%) and respiratory distress leading to making 65.3% received care in the NICU. Most of the children had spastic CP (69.1%), severe (51.8%), quadriplegia (71.4%), only 27% communicated verbally and 53% were attending school regularly. It can be concluded that most children had severe sensory-motor and the first signs of such involvement were perceived by their families, although the majority have received pediatric care routine in the first year of life, few have been evaluated and received some guidance on the psychomotor development during the consultations, a fact that makes us aware of the need to make awareness among the primary care team about the importance of regular assessment of developments in the first year of life, so that we can to identify and refer children with potential delays and serious illnesses such as PC-time increasingly skilled, increasing the likelihood of a better quality of life.

M.Ed. / The constitution of South Africa provides for the rights of all citizens in respect of equality of opportunities. Education is seen as the right of all learners. This is also emphasized by the National Higher Education Policy which makes provision for learners with disabilities to be educated in main stream institutions. However, little research has been done in this respect. The purpose of this study is to examine and describe my education career with specific reference to teaching and learning. The purpose of this is to deepen the knowledge and understanding of the needs of people with disabilities. In this study a narrative is written on my Higher Education career. Certain themes are highlighted. I start by describing my school career from nursery school to secondary school and then give a detailed account of my Higher Education career. The themes that I highlight are emotional support from the parental home, the attitude of the institution and personnel, social life, the emotional aspects of my Higher Education career and accessibility. I continue by discussing the problems I had in my various vocations. I then do a literary study and discuss cerebral palsy, perceptual problems and dyspraxia. Hereafter the system theory with specific reference to the family is discussed. Then I look at the literature as far as students with disabilities are concerned. I continue by discussing the personality development of people with disabilities referring to the personality theories of Erik Erikson and Viktor Frankl. A reflection on the study is done and a personal reflection is also done. The following recommendations is being made with regard to tertiary institutions. Firstly the institution should be accessible for wheelchair users. Secondly lecturers should be supportive and understanding towards students with disabilities. A social supportive system is recommended. The main finding with regard to people with cerebral palsy is that a child should be educated as far as her disability is concerned so that she can learn to cope with her disability. The learner should also be made aware of her own duty to explore her disability. Parents should also be supportive and realistic career guidance should be given to learners with disabilities. Visual perceptual problems and dyspraxia should be taken care of before the age of ten. I conclude by suggesting certain topics for further study and pointing out shortcomings of this study.

Cerebral palsy is a neurodevelopmental condition that severely impedes a child?s development. Many children with this developmental disorder may have complex limitations in self-care functions which renders them completely reliant on their caregivers. This study explores the experiences of kinship caregivers of children with cerebral palsy. The study has been based on the concern that despite extensive research on the experiences of caregivers caring for children with cerebral palsy, little research has been conducted about the experiences of kinship caregivers who care for children with this developmental disorder in a Botswana context. The aim of this research has been to understand the experiences of kinship carers who care for children with cerebral palsy in Mahalapye, Botswana. The researcher had adopted a qualitative exploratory approach. Non-probability purposive sampling and volunteer sampling had been utilised to select the research participants. Qualitative data had been collected by utilising one-to-one semi-structured interviews. A total sample of 12 participants had been drawn from the pool of caregivers of children between the ages of six and twelve who have been diagnosed with cerebral palsy and who reside in the Mahalapye Village. The study findings show that caring for a child with cerebral palsy exposes kinship caregivers to many challenges such as burden of care, impaired health, poverty and stigmatisation. Some of these challenges are attributed to the child?s disability while some are due to insufficient services provided to caregivers. However, acceptance of the child, religious beliefs and the supportive role played by family members enable the caregivers to adapt to life with a child diagnosed with cerebral palsy. The study concludes that challenges faced by kinship caregivers raising children with cerebral palsy in Botswana is aggravated by inadequate intervention programmes and services that could assist caregivers and disabled children, despite a firm and comprehensive national policy on care for people with disabilities. The intervention care programme should bestow more focus on recognising caregivers? challenges and removing such obstacles by providing effective services. A support programme that could ensure continuity of care will benefit caregivers by assisting them in adapting. The study suggests that programmes that have been designed to enhance identified family resilience quality, which help families to adapt following the diagnosis of cerebral palsy of a child, should be implemented. / Mini Dissertation (MSW)--University of Pretoria, 2017. / Social Work and Criminology / MSW / Unrestricted

Magister Scientiae (Physiotherapy) - MSc(Physio) / About 10% of children world-wide experience developmental disorders and require access to the health care system. These disorders also require extensive care giving, often throughout childhood and into the adult years. Cerebral palsy (CP) is one such chronic condition, and can serve as a major cause of childhood disability. It is the commonest cause of neurological impairment in childhood and is associated with functional limitations and lifelong disability. Providing the high level of care required by a child with long-term functional limitations can become burdensome and may impact on both the physical and psychological health of the care giver. To prevent problems suffered by mothers of children with CP, it is important to explore the challenges experienced. All studies conducted previously on cerebral palsy in Zambia focus on impairments and difficulties experienced by children with CP and none of the mothers’ challenges have been explored. The aim of this study therefore was to explore the challenges that mothers of children with cerebral palsy experience in Ndola, Zambia. The study was conducted at two rehabilitation centers (Twapia and Mushili) under the Community Based Rehabilitation (CBR) catchment area in Ndola. A qualitative research design was employed. The mothers were stratified and purposefully selected and interviews were stopped once theoretical saturation was reached. Permission to conduct the research was obtained from relevant bodies and ethical issues were observed throughout the study. Sixteen (16) mothers of children with CP were interviewed. In-depth interviews were done using an interview guide which was designed after extensive review of literature. The interviews were audio recorded. The recorded data was transcribed verbatim and thematic analysis was used to analyze the data. The results showed that the mothers faced many challenges which included emotional, physical health, socio-economic, environmental, misdiagnosis of the condition of their children, marital problems and lack of implementation of policies regarding children with CP by the Zambian government

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Erb's Palsy results from excessive displacement of the head during birth causing traction on the Brachial plexus. In order to define optimal management for Erb's Palsy, reliable data is needed. Aim: The aim of the study was therefore to determine the profile of and caregiver experiences of infants with Erb' Palsy seen at Groote Schuur Hospital. Method: The study was carried out at Groote Schuur Hospital (GHS) in the Western Cape, South Africa. The study used both quantitative and qualitative approaches. A record review was conducted to collect quantitative data which was retrieved from patient files and captured on a data extraction sheet. A convenient sample of caregivers of children with Erb's Palsy were recruited and interviewed for the qualitative component of the study. Quantitative data was analyzed and presented in tables, figures and qualitative data was analyzed thematic and presented narratively. Ethical approval was obtained from the Ethics Committee at the University of the Western Cape and the University of Cape Town. In addition, permission was obtained from the hospital management. Results: The total sample size for the quantitative part was ninety-six (96) files of children with Erb's Palsy. The mean age of the study sample was 3.8 months. The majority (53.1%) of the participants received a mean of 4.1 (SD=1.7) physiotherapy session. In the qualitative phase eight participants were interviewed. Analysis of qualitative data yielded three themes including "experience of mothers as it relates to Erb's Palsy", "mothers' engagement with health care providers" and "personal and environmental factors". Conclusion: The study within this setting indicated that Erb's Palsy was most common among females. The most common documented forms of physiotherapy techniques provided for children with Erb's Palsy in setting were stretching and strengthening exercises as well as therapeutic massage. exercise. Caring for a child with Erb's Palsy resulted in emotional challenges experienced by the mothers of these children.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / The lack of an effective method for teaching oral hygiene procedures to parents of handicapped children prompted this investigation. Seventy-nine preschool cerebral palsy children were randomly distributed according to age and sex into three groups. The parents of these groups received the following instruction: Group I - written instructions for a detailed approach to oral hygiene maintenance in the home as if the child were without handicap; Group II - written instructions for a specialized approach to home oral hygiene maintenance with emphasis on two people providing the care, and mouth propping for access and stability of the arms and legs; Group III - no specific oral hygiene instructions. Each child in each group received a thorough oral examination and deposits of dental plaque were disclosed, numerically scored and recorded. Each parent of the three study groups participated in a written examination of dental knowledge at each visit. After each examination, the correct answers were given to the parent by both a verbal and written response. Parents and children returned at 90-day intervals. Variables such as transportation, surgery performed during the period of study, deteriorating health in the child, parental apathy about dental problems, and change in family job or location, reduced the sample from seventy-nine to fifty-four subjects, with data being obtained for pre- and post- examination periods. Both test group of parents significantly improved their dental knowledge scores after ninety days. However, none of the children decreased their plaque enough to show statistical significance. Perhaps there was some motivational improvement in the Group II parents, as they returned for the examination at a better rate, judged to be significant as compared to the other groups. Further investigation is recommended either to study the technique by itself without a time interval between scores or to evaluate the factors of intelligence, economic level, gravity of medical situation, and sibling support as they offset changes in behavior. Until then, it appears on the basis of this study that it is possible to increase the parent's knowledge of oral health but that changing the behavior of the parent actually performing the task is much more difficult.