Thesis (Ph. D.)--University of Oregon, 2005. / Includes bibliographical references (leaves 115-119)

xiii, 103 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / The purpose of this dissertation was (1) to investigate the effects of dual task conditions on the development of postural control during gait in typically developing children while walking and obstacle crossing, and (2) to investigate the attentional requirements of gait in children with cerebral palsy (CP). Forty younger and older typically developing (YTD and OTD) children and 10 children with CP performed a gait task with and without a concurrently auditory Stroop task. Gait and cognitive performance were measured. In study 1, dual task interference with gait performance was found in YTD and OTD children, but not in healthy young adults (HYA). In general, gait performance decrements under dual task contexts were greater in YTD than OTD children, whereas cognitive performance decrements during dual tasking were not different between the two groups of children. Dual task interference was lowest in HYA and highest in YTD children when compared among groups. As the difficulty of the gait task was increased, dual task affects on cognitive performance were now found in YTD and OTD children, but not HYA. In study 2, there were significant differences in dual task interference affecting gait performance in all groups of children. When performing the gait task with a concurrent auditory Stroop task, OTD children showed greater dual-task costs than children with CP for accuracy, but children with CP demonstrated greater dual-task costs than OTD and YTD children for medial Center of Mass-Ankle-joint-center inclination angle. This increased medio-lateral inclination angle in dual task situations has also been seen in older adults with balance deficits and may be associated with an increased risk for falls. YTD children showed dual-task costs in a slowing of gait velocity and stride time, a safer strategy than that used by children with CP. The lower cognitive performance during dual tasking for OTD children suggests that they allocate greater attention to maintain gait stability, whereas YTD children and children with CP do not. In addition, children with CP use a behavior that may increase their risk of falls in complex environments. This dissertation includes unpublished co-authored material. / Committee in charge: Marjorie Woollacott, Chairperson, Human Physiology; Paul van Donkelaar, Member, Human Physiology; Li-Shan Chou, Member, Human Physiology; Paul Dassonville, Outside Member, Psychology

Magister Scientiae (Physiotherapy) - MSc(Physio) / The extent to which customers are satified with the care they receive from the health professionals has been an important area of interest for researchers, managers and health care workers. The physiotherapy cerebral palsy clinic at Mulago Hospital in Kampala Uganda provides physiotherapy services for parents caregivers of children with cerebral palsy. The parents caregivers visit the clinic seeking physiotherapy services that will address their problems and those of the child. The purpose of this study was to explore the satisfaction that the parents caregivers of children with cerebral palsy get from utilising the physiotherapy services at the clinic and to identify the barriers problems that they encounter that might affect their attendance. / South Africa

M.Ed. / The aim of this research study was to conduct Narrative Therapy with an adolescent with cerebral palsy and a cognitive disability, to determine his experience of the disability. The study was motivated by the fact that no research has been conducted in South Africa on therapy with adolescents living with cerebral palsy and cognitive disability. The reason being that it was believed that a client needs to have the cognitive ability for therapeutic change to occur. Recent international research has proved that therapy can be successful with clients with cognitive disabilities, if the approach or techniques are on the client’s cognitive developmental level. The goal of the study was firstly to give a voice to a seventeen-year-old adolescent with cerebral palsy and a cognitive disability to tell his story. Secondly, to determine what internal resources he has to help him cope with the disability. Lastly, to make recommendations for other therapists who want to conduct therapy with adolescents living with disabilities. A qualitative research approach with a single case study as research design from a selected sample was used. A qualitative approach is useful in studies where the meaning individuals give to there experience are investigated. The focus is on a seventeen-year-old adolescent with cerebral palsy and a cognitive disability and his experience of the disability. The researcher as therapist uses Narrative Therapy to describe and document the adolescent’s experience. Data was gathered through a variety of techniques (interviews, Narrative therapy sessions, observations and therapeutic letters), which enhanced the reliability of the study. The researcher was also the therapist who conducted Narrative Therapy and she had the opportunity to explore and describe the adolescent’s experience. From the data, certain themes and sub-themes were identified that highlighted aspects of living with a disability. / Me. H. Krige

Philosophiae Doctor - PhD / This study attempted to ascertain whether the under-representation of black, disadvantaged learners with cerebral palsy in biology and related careers is linked in any way to the method and content of teaching and learning in special education. In addition this study also attempted to identify and uncover the barriers that prevent learners with cerebral palsy from pursuing careers in science and technology related professions. / South Africa

Young children with HCP experience difficulties performing age-appropriate daily activities such as self-care and play. Research in neuroplasticity has shown that intensive, task-specific training in early development is ideal to maximize functioning in children with HCP. The aim of this study was to analyze the feasibility of a new manualized clinical guideline, Family Activity Adaptation Model (FAAM), via Telehealth to coach families to develop daily activities and routines that facilitate functional bimanual skills in young children with hemiplegic cerebral palsy (HCP). Ten caregivers and children with HCP (3-7 years) received virtual training on how to embed bimanual intensive training (HABIT) into their everyday activities and routines on their own at home for 90 minutes a day, 5 days a week over 8 weeks. Caregivers and children received virtual coaching using the FAAM method 2 times per week. FAAM Activity Analysis was used to describe manual development. Daily activity logs were used to assess family adherence and home program feasibility. Bimanual functional goal performance and satisfaction was measured using the Canadian Occupational Performance Measure (COPM). Perceived changes in overall bimanual functional skills were evaluated using the Mini-Children’s Hand Use Experience Questionnaire (Mini-CHEQ). Caregiver stress, burden and program satisfaction was monitored using the Parenting Stress Index (PSI-4-SF), the Ease of Caregiving for Children measure and a caregiver satisfaction survey. The measures were assessed immediately prior to (pretest), midpoint (burden measures only, repeated measures ANOVA) and immediately after (posttest, Wilcoxon Sign Rank Test) the intervention. All families made statistically and clinically significant improvements in goal performance (p=.008) satisfaction (p=.007), and overall bimanual hand use (p=.035). All families completed daily logs and practiced strategies for an average of 81.37 (SD=7.069) minutes a day. Caregiver burden and stress remained consistent throughout the study and all caregivers reported satisfaction with the program. This is the first study to manualize a family centered, telehealth-delivered intensive motor training program. This study adds a continuum of care and access to services for children and families with limited resources. The study supports clinicians with home program design and meets the individual needs of families using resources in their natural environment.

The normal development of articulation is built upon the normal development of motor skills (Morris, 1970). Cerebral palsy is caused by brain damage and is characterized by neuromuscular incoordination. This interferes with normal development of motor skills. It also may interfere with normal development of speech if dysarthria is present. Because of these factors, the synergy of movement of the oral muscles used in feeding, in speech and in execution of diadochokinetic movements of the oral muscles is affected. The purpose of the study was to determine whether or not the performance of feeding skill movements or the performance of diadochokinesis of the oral muscles was significantly related to the synergy of movement for speech. The end purpose of the design was to determine whether or not articulatory proficiency in cerebral palsied children might be predicted from a feeding skills or diadochokinetic test.

Health is a multidimensional, holistic, concept integrating physical and mental health. In childhood, the most common cause of physical disability is Cerebral Palsy (CP). For individuals with CP, health and well-being is impacted by the complex interactions among their physical impairments, activity, participation and environmental barriers. Although CP is considered non-progressive, secondary conditions (pain and fatigue) and their functional consequences have been found to worsen as the individual with CP ages. While preliminary evidence shows that many of the physical impairments (pain, fatigue, depression) reported in adults with CP begin during late adolescence, there is little information about the role personal and environmental factors, impairments, activity limitations, and participation restrictions have on health and well-being of young adults with CP. To understand the health and well-being of young adults with CP, the International Classification of Functioning, Disability and Health (ICF), a World Health Organization framework, guided the selection of survey instruments for this study. Surveys were sent to 610 young adults (18-30 years) with CP. 95 surveys were returned, 55 were self-reported and 40 were completed by proxies. Increasing severity of impairment was associated with decreased participation in daily activities and social roles, while loss of ambulatory ability, pain, fatigue, depression, and activity level did not differ by severity of impairment. Environmental barriers restricted the level of participation only for the self-report participants. Health status was decreased in those who self-reported increased pain, fatigue, and depression; offset by emotional support. Life satisfaction was decreased by depression and poor health; offset by emotional support. Addressing the physical impairments, activity limitations, participation restrictions, personal factors and environmental barriers impacting young adults with CP requires coordinated efforts among the medical, educational and vocational systems. These efforts need to begin early with appropriate assessment and treatment of impairments, provision of assistive technologies and augmentative communication, and adaptation of the environment to facilitate participation in activities and social roles. The health and well-being in young adults with CP can also be improved with enhanced emotional support beyond the family unit through peer support groups, mentors, and other adult role models.

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Speech Pathology), 2017 / Background: The relevance and effectiveness of speech therapy interventions for children with Cerebral Palsy (CP) has come under scrutiny within the CP community. There is a need for evidence based research to be conducted within the CP population. Specifically with regard to the current speech therapy interventions that are being used for this population. There is a dearth of literature in favour of the efficacy of speech therapy interventions for the CP population. Furthermore, research within the South African context is required so as to identify the culturally specific needs of the population. In addition, South Africa faces challenges in providing culturally specific, cost effective and evidence based intervention for this population. This can be attributable to barriers such as the lack of human and financial resources. Purpose: The main aim of the study was to measure change in the use of communicative functions of nine children with cerebral palsy following a five week parent training program. The main aim was achieved with the following sub-aims; 1) To assess the participant’s baseline performance in the use of communicative functions before the commencement of the parent training, 2) To assess the participant’s performance in the use of communicative functions after the 5 week parent training had taken place, 3) To assess the participant’s performance in the use of communicative functions 3 months after the post intervention assessment and 4) To describe the effectiveness of a parent training program in improving a child with CP’s ability to make use of communicative functions. Method: The parents of nine children underwent a parent training program namely the Malamulel Onward Carer-2-Carer Training Program. The nine children were assessed before, immediately after and 3 months after the intervention. The scales, namely the Preschool Language Scale-5 and the Communication Matrix were used in the baseline assessment and reassessment phases of the study and yielded numerical data that described the children’s communication abilities. Results: All the children (n=9) demonstrated a positive increase in communication from test 1 through to test 3 on the Communication Matrix. The p-value for test 1 to test 2 was p=0.0078, test 2 to test 3 were p=0.0313 and test 1 to test 2 were p=0.0313 indicating significant change. The performance on the PLS-5 for majority (n=8) of the sample was unexpected. The majority of participants (n=7) displayed an increase in the PLS-5 score from test 1 to test 2; with one participant displaying a positive change across all three testing occasions on the PLS-5. However, a decrease in the PLS-5 score was seen in majority (n=5) of the participants from test 2 to test 3. Conclusion: Based on the findings of this research, the use of parent training appears to be a viable form of intervention to improve the use of communicative functions in children with CP. However, further steps need to be taken to incorporate an individual follow up component after the parent training to ensure carry over and maintenance of skills covered in the workshops. In addition, due to questions around the efficacy of the PLS-5 with individuals who have CP, assessments need to comprise of a standardized tool in addition to an observational tool so as to acquire a more holistic view of a child with CP’s communication skills. / XL2018

Postural control is essential for maintaining an upright sitting position. However, children with Cerebral Palsy (CP) Gross Motor Function Classification System (GMFCS) IV-V present with impaired postural control, often limiting their daily function and environmental interaction. Most interventions targeting postural dysfunction in CP consider the trunk as a single biomechanical segment and are challenging to use in the GMFCS IV-V population. The aim of this study was to develop the Segmental Intensive Trunk Training (SITT), which uses the segmental model of trunk control. The motor learning framework was chosen for structuring SITT to be an intensive approach, with a dosage of 2hrs/day, 3days/week for 4 weeks (24 hours). The development process included the test of feasibility and the initial evidence of effects, using a single subject research design (SSRD). An A-B-A design was used, where the first phase A included 4 baseline assessments, and phase B included the 4 weeks of SITT intervention. The second phase A was the withdrawal period including an immediate posttest, post 1 week test and a 3 month follow up evaluation. Postural control and reaching behavior were assessed during all 3 phases, using the Segmental Assessment of Trunk Control (SATCO) and Seated Postural and Reaching Control Test (SP&R-co). Hand dexterity and function was measured using the Box and Block test, and ABILHAND-kids questionnaire. Gross motor function was measured using the Gross Motor Function Measure Item Set (GMFM-IS). Performance on functional goals was assessed using the Canadian Occupational Performance Measure (COPM). Data analysis was descriptive, including visual analysis and the two standard deviation band method. One participant (11 years, GMFCS V) participated in the study with a 100% completion rate and 88% participation rate. SITT was a feasible approach for training segmental postural control and reaching behavior in children with CP GMFCS V. The improvements in postural control were associated with an improvement in manual dexterity, gross motor function, functional goal performance, and performance-related satisfaction. The gains in static control and COPM performance and satisfaction were retained at 3 months. These improvements were seen in the areas of body structure and function, and activity domains. Progress in motor performance in response to SITT was established at an individual level; however, more evidence is needed to establish the external validity of the approach.