O presente estudo teve como objetivo avaliar o efeito de prática mental e sua associação com prática física na aprendizagem em uma tarefa envolvendo velocidade e precisão, em adolescentes com paralisia cerebral (PC) do tipo hemiparesia, comparando o efeito de lesões nos hemisférios cerebrais direito versus esquerdo. Participaram deste experimento 31 adolescentes com PC, os quais foram distribuídos em quatro grupos: (a) prática mental com hemiparesia direita, (b) prática mental com hemiparesia esquerda, e grupos controle com hemiparesia (c) direita ou (d) esquerda. A tarefa motora consistiu em tocar um alvo empregando o braço parético com demanda de precisão e rapidez. As sessões de prática foram divididas em dois dias. No primeiro dia, os grupos experimentais realizaram duas sessões de prática mental, sendo que cada sessão foi constituída de 5 blocos de 10 ensaios mentais. Os grupos controle realizaram nesta fase um jogo em microcomputador. No segundo dia, os grupos experimentais e controles receberam o mesmo tratamento, realizando prática física na tarefa. As avaliações motoras foram feitas imediatamente após as atividades do primeiro dia do experimento, e antes, imediatamente após e 30 min. após o fim da sessão de prática física. As análises dos resultados mostraram uma superioridade da prática mental em relação à prática física no tempo de movimento e índice de retidão. A prática física isolada apresentou superioridade na diminuição do deslocamento vertical da mão e na diminuição da quantidade de unidades de movimento. Os efeitos observados foram persistentes, indicando ganho de desempenho derivado de aprendizagem. Não houve diferença significante associada ao lado da lesão em nenhuma das variáveis analisadas. Os resultados do presente estudo revelaram que a prática mental foi efetiva em promover aprendizagem de forma equivalente entre indivíduos com lesão no hemisfério direito ou esquerdo / The present study aimed to evaluate the effect of mental practice on learning a task involving speed and accuracy in adolescents with hemiparethic cerebral palsy (CP), comparing the effect of lesions to the left versus right cerebral hemispheres. Participated in this experiment 31 CP adolescents who were assigned to four groups: (a) mental practice with right hemiparesis, (b) mental practice with left hemiparesis, and control groups with (c) right or (d) left hemiparesis. The motor task consisted of fast aiming at a target using the paretic arm. The practice sessions were divided into two days. On the first day, the experimental group held two sessions of mental practice, each session consisted of five blocks of 10 mental rehearsals. The control group played on a microcomputer game. On the second day, experimental and control groups received the same treatment, having physical practice on the task. Performance tests were made immediately after the activities of the first experimental session, and before, immediately after, and 30 min. after the end of the second session. Analysis of results showed a superiority of mental practice in relation to the physical practice in movement time and index of straightness. The physical practice alone was superior in reducing the vertical displacement of the hand and the decreased amount of units of movement. Those effects were persistent over time, indicating performance gains derived from learning. No significant differences associated with side of lesion were found. These results revealed that mental practice was effective in inducing learning similarly between individuals with lesions to the right or left cerebral hemispheres

Introdução: O aumento da rotação interna dos quadris é a causa mais comum de desvio interno dos pés na paralisia cerebral. A osteotomia de rotação externa do fêmur tem sido a forma preferencial de tratamento para os casos com aumento da anteversão femoral; no entanto, permanecem controversos os dados e fatores relacionados à recidiva do problema. Métodos: Estudo retrospectivo, com avaliação clínica e cinemática de 75 pacientes (99 osteotomias) com paralisia cerebral tipo diparesia espástica, com tempo de seguimento médio de 1 ano e 10 meses, submetidos à osteotomia de rotação externa do fêmur proximal. Os pacientes foram divididos em dois grupos, de acordo com a correção ou persistência da rotação interna do quadril durante a marcha na cinemática após a cirurgia. Os pacientes, com correção mantida na primeira avaliação, foram convocados para novo exame, realizado em média 4 anos e 5 meses após a osteotomia femoral. Os grupos foram comparados com uso dos Testes de Igualdade de Duas Proporções, Mann-Whitney e Wilcoxon. Resultados: Na primeira avaliação, realizada em média 1 ano e 10 meses após a osteotomia femoral, 33,33% dos membros tratados apresentavam persistência da rotação interna do quadril. Dos 54 pacientes com manutenção da correção na primeira avaliação, 35 (42 lados) retornaram para a segunda avaliação após em média 4 anos e 5 meses, quando foi observada recidiva da rotação interna do quadril em 9,53% dos casos. A persistência da rotação interna do quadril na primeira avaliação pós-operatória mostrou relação com o tipo de fixação interna utilizada na osteotomia femoral. O uso da placa angulada foi mais frequente nos pacientes com correção mantida, e a placa reta DCP foi mais usada no grupo de pacientes com persistência da rotação interna (p=0,033). Na segunda avaliação, a recidiva esteve relacionada com a realização da osteotomia femoral em pacientes mais jovens (p=0,032). Conclusão: A persistência da rotação interna do quadril após a realização da osteotomia de rotação externa do fêmur foi observada em um terço dos casos, e a realização da osteotomia femoral na região subtrocanteriana e fixação com placa reta DCP foi mais frequente nesse grupo de pacientes do que nos que mantiveram a correção. A recidiva da rotação interna esteve presente em 9,53% dos casos, e a idade de realização da osteotomia femoral foi menor nos pacientes com recorrência / Introduction: Hip internal rotation is the most common cause of in toeing gait in cerebral palsy and femur external derotational osteotomy has been the preferential treatment option in cases with increase of femur anteversion, however the factors related to recurrence of the problem still controversial. Methods: Retrospective study, with clinical and kinematic evaluation of 75 diparetic spastic cerebral palsy patients, with mean follow-up time of 1 year and 10 months, underwent proximal femur external derotational osteotomy. The patients were divided in two groups according the correction or persistence of hip internal rotation during gait at kinematics after surgery. Patients with correction achieved were asked to come back for a second analysis, after a mean follow-up time of 4 years and 5 months. The groups were compared using two proportions equality test, Mann-Whitney test and Wilcoxon test. Results: In the first evaluation, with mean follow-up of 1 year and 10 months, 33.33% of osteotomies shown persistent hip internal rotation. Thirty-five of 54 patients of hip internal rotation correction at first evaluation came back for the second analysis after a mean follow-up time of 4 years and 5 months, when was observed a recurrence in the 9.53% of cases. The persistence of hip internal rotation at first evaluation after surgery exhibited relation to type of internal fixation used at proximal femur. The use of blade plates was more frequent at patients with correction achieved whereas dynamic compression plates were used more frequently in the group of patients of persistent hip internal rotation (p=0.033). In the second evaluation, the recurrence was related to femur osteotomy in the earlier age (p=0.032). Conclusion: The persistent hip internal rotation after femur external derotational osteotomy was observed at 33.33% of the cases and the use of dynamic compression plate for fixation was more frequent than the group with correction achieved. The recurrence of hip internal rotation was observed at 9.53% of the cases and the femur osteotomy was performed in earlier age in this group

This study examined factors that influence marital satisfaction in couples raising a child with cerebral palsy. The theoretical frameworks for this study were drawn from family systems theory and the social ecology model. Twenty-eight married couples raising a child between the ages of 3-17 years, with a diagnosis of cerebral palsy, comprised the sample for this study. Participants were classified as raising a child who is mildly/moderately or severely impaired by cerebral palsy. Participants were recruited through referrals of professionals working in local organizations that provide services and support for persons with disabilities and their families. Data were analyzed using correlation, and two-tailed 1 tests. Analysis was based on the following research question: To what extent is the marital satisfaction of couples raising a child between the ages of 3-17 years with a diagnosis of cerebral palsy influenced by couple cohesion and adaptability, individual coping style, and sources of family and community support? Statistical analysis revealed that for most couples, cohesion and adaptability as measured by FACES II were associated with higher levels of marital satisfaction. For wives, Coping Style I: Maintaining Family Interaction, Cooperation, and an Optimistic Definition of the Situation as measured by the Coping Health Inventory for Parents was found to be positively associated with their marital satisfaction. Husband 's coping style was not found to be significantly and positively correlated with their level of marital satisfaction. Analysis of family and community support were not performed due to low alpha reliabilities for both husbands and wives on the Family Support Scale, and the failure of its subscales to hold together. Bivariate correlations of the severity of the child 's disability with the parent's level of marital satisfaction were nonsignificant for both husbands and wives. Findings from this study support the notion that marital satisfaction in couples with a child with cerebral palsy may be enhanced by couple cohesion and adaptability. Wives who cope by strengthening family life and relationships, and who have a positive outlook on liFe may also experience greater levels of marital satisfaction. Future research with larger samples of couples is needed to replicate these findings.

AIM: The aim of this study was to investigate which physical therapy methods are most effective for improving the postural control in children and adolescents diagnosed with CP, in order to provide to physical therapists with new evidence on the topic for integrating them in theirs intervention plans. METHOD: A systematic literature review was conducted in order to collect all the relevant information according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Five databases (PubMed, ProQuest, CINAHL, Web of science and Scopus) were used to identify relevant studies to include in this review. Keywords included “physical therapy”, “postural control”, “cerebral palsy” and their synonyms. Inclusion and exclusion criteria were settled according to the research question. RESULTS: Following the exclusion and inclusion criteria and after the quality assessment of the yielded data 11 articles were included in this review out of 97 of the initial search. PT interventions that were identified in the review included aquatic physical therapy, electrical stimulation therapy, intensive upper- and lower-extremity training (HABIT-ILE), virtual reality therapy and reactive balance exercise and standard PT combined with other methods such as backward walking training, Whole Body Vibration (WBV) training and antigravity treadmill training. CONCLUSION: In order to achieve improvements in postural control that are maintained over a period of time, children with cerebral palsy need to have PT included in their everyday routine and to have consistency in their sessions. All the PT interventions showed some positive effects on PC but, as Cerebral Palsy has many classifications and the effects of it varies for each child the PT method needs to be adjusted  to meet each child´s individual characteristics and disability and also to their environmental needs.

Disability is a state which questions one’s social standing. Individuals with disability are often seen shunned and sheltered from the society. It is understood that one cannot expect the world to revolve around us, rather we make adjustments to make life smoother. This thesis looks at non-verbal communication strategies within one case study who suffers from Cerebral Palsy and multiple communication needs. The major share of the thesis looks at the multimodal communication where the communication and bodily gestures gain prominence.   Cerebral Palsy, in an overview, (CP) is a group of permanent neurological disorder that affects one’s body movement and muscle coordination, commonly seen in an infant stage or early childhood caused by the damage to the brain that hinders the brain’s ability to control movement and posture of the body. CP affects the outer layer of the brain that directs the muscle movements. Alongside a stationary characteristic, a lot of motor, sensory and intellectual impairments accompany the disorder. These characteristics mark the beginning of life for the CP injured and is seen affecting their physical, mental and social existence, limiting their abilities of motor and oral skills impairing the ability of speech. Physique alterations include changes in jaw structure, lips and tongue making it nearly impossible in articulating words (Geytenbeek, 2011). Communication is an integral part of any relation. Feelings and emotions are often conveyed through communicating it in two different ways- verbal (psycholinguistics) - that involves a lot of ideas, messages conveyed through words and speech for communication and non-verbal (psychobiological) - involves facial and bodily expressions. My prime target is the latter’s way of communication, how these non- verbal communication can be interpreted, how do the family members and personal assistants decipher the expressions and understand subtle nuances. The complexity of communication within this group is further intensified by the power structures and decision makers in the society. It also tries to look at different models of communication and the strategies to make communication effective among the disabled group. Communication is very mutable and through this dissertation I try to analyze techniques that gives visibility to varied experiences and turning them into representations of certain ideas. Also it tries to unravel the emerging problems within the communication arena, misinterpretations thus reaching a conclusive hypothesis that communication is constantly irregular and fluctuating according to distinctive time, person and space.

Young women with mobility limiting disorders face many challenges as they move through adolescence into young adulthood. In addition to the challenges of this developmental period, they must consider their disability as they manage their lives. Competent decision making is a foundational skill for self-management and for transition in adulthood. It is also a protective factor for resilience.There is little research on decision making in adolescents with disabilities. Therefore, the purpose of this qualitative study was to explore the decision making experiences of female adolescents and young women with mobility limiting disorders. Theoretical underpinnings for the study included Resilience Theory and Phenomenology. Phenomenological methodology guided data collection and analysis. Study participants included six young women between the ages of 16 and 25 who met established inclusion criteria. Participants were interviewed using an interview schedule. Transcripts of the audiotaped interviews were analyzed for themes. An individual profile of decision making in self-management for each participant was developed from analysis of interviews. A composite depiction of the phenomenon of decision making in self-management was developed from analysis of the participant profiles. The following conclusions were drawn from the composite depiction. Decision making in self-management is a dynamic, developmental process that encompasses choices across many dimensions of life activities. Parents' attitudes and expectations can have significant influence on the development of decision making in young women with mobility limiting disorders. Having or taking the opportunity to make decisions may contribute to the development of decisional competence and independence. Barriers, such as social stereotypes and lack of community resources, influence decision making. The ability of the study participants to "see past the disability" creates a broader vision of opportunities for decision making to achieve their goals.The results of this research should be useful to nurses and other health professionals as they collaborate with adolescents with disabilities and their families in fostering and supporting competent decision making in self-management. Future research is recommended on decision making in specific dimensions of self-management such as socialization and, using quantitative and qualitative methods to compare this phenomenon in adolescents with and without disabilities and between genders.

The diploma thesis is focused on psychomotor development in children with cerebral palsy in context of persisting primitive reflexes. Opening chapters summarize theoretical knowledge about cerebral palsy, its etiology, clinical picture, forms and comprehensive diagnostics, including special education. The next part of the thesis focuses on psychomotor development of a child with cerebral palsy, in particular the gross and fine motor activity development and speech development. The main section of the thesis discusses the neurophysiological principles of primitive reflexes and their relevance for early development of a child. The primitive reflexes, one by one, as well as the influence of their persistence on the psychomotor development of the child with cerebral palsy and options of their integration by selected therapeutic concepts are presented. Attention is also paid to the importance of multidisciplinary cooperation of medical rehabilitation and special pedagogical care in the field of primitive reflexology. The practical part is based on qualitative methodology ad its operates with data gained from three case studies. The aim of the diploma thesis is to examine by means of case studies whether or not the integration of primitive reflexes demonstrably improves the psychomotor skills, behavior,...

Thesis (M.Ed. (Educational Psychology)) --University of Limpopo, 2014 / Self-concept is a driving force, (Barongo & Nyamwange, 2013: 7) and Harter (1998: 559) pointed out that improved self-concept is an important means to enhance other desirable outcomes like, self-acceptance and academic improvement. The purpose of this study was therefore to explore the self-concept of adolescent learners with cerebral palsy in special schools in Limpopo Province, to check their level of selfconcept. The objectives of this study were to determine if cerebral palsy affects the self-concept of these learners, to measure their level of self-concept and to find out if intervention improves their self-concept. The sample was selected by means of random sampling. The Self Descriptive Questionnaire (SDQ) with nine subscales was administered to a group of participants, 65 adolescent learners with cerebral palsy, (30 males and 35 females) at the three special schools; Helena Franz, Letaba and Tšhilizini. The questionnaire was administered to the respondents twice, before and after intervention. Pre-test and post-test were done at Helena Franz Special School since it was the only high school among the three special schools catering for cerebral palsied learners in Limpopo Province. The empirical investigation revealed that the self-concept of adolescents with cerebral palsy in special schools in Limpopo Province is not negative but just leaning in the direction of the positive judgments. It further indicated that cerebral palsy affects the self-concept of the adolescent learners and that intervention has a positive impact on the self-concept of adolescent learners with cerebral palsy

[Truncared abstract] Introduction: The assessment of any therapy requires not only an understanding of how that therapy works but also how it affects health related quality of life (HRQOL). Botulinum Toxin A(BoNT-A) therapy for upper limb spasticity management in children with hemiplegic cerebral palsy(CP) is currently under trial. Despite its use for over a decade for lower limb spasticity, little is known about the mechanisms involved in improving motor function and the effect on the child and their familys HRQOL. Both central and peripheral mechanisms are hypothesised[1]. Whilst evidence of improved quality of movement and ability to perform tasks is emerging[2-4], this cannot be directly correlated with an improvement in HRQOL. In addition, the traditional method of assessing child HRQOL by parent proxy reports has come under question[5, 6]. The World Health Organisation now recommends the collection of both parent proxy and child self-reports[7]. Aims: 1. Investigate the corticomotor projections to the upper limb in school aged children with hemiplegic CP and the changes that occur with BoNT-A therapy by transcranial magnetic stimulation (TMS). 2. Investigate the effect of upper limb BoNT-A therapy on HRQOL of school aged children with hemiplegic CP by completion of the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 3. Determine the concordance between Child Self-Report and Parent Proxy Report scores for the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 4. Determine the concordance between PedsQL scores and function as assessed by the Melbourne Assessment of Unilateral Upper Limb Function (MUUL). Methods: Design: Prospective randomised pilot study. Setting: Department of Paediatric Rehabilitation, Princess Margaret Hospital, and Centre for Neurological and Neuromuscular Disorders, Perth. Participants: 22 school aged children with hemiplegic CP aged 7yr 0mth-13yr 11mth (12 treatment, 10 control). 3 Treatment: One episode BoNT-A injections (dose 1-2U/kg/muscle) into the upper limb for treatment group. The control group received usual care. ... Conclusion: This pilot study provides preliminary evidence of the effects of upper limb BoNT-A therapy at both a central physiological and a broader quality of life level in school aged children with hemiplegic CP. At a central level, corticomotor pathway reorganisation occurs in the setting of BoNT-A. However the reorganisation is not limited to the affected side pathways suggesting a systemic BoNT-A effect or developmental changes. Similarly, in this pilot study, there was no statistically significant effect of upper limb BoNT-A on the childs HRQOL as assessed by the PedsQL although positive trends were observed 4 for a number of physical and psychosocial domains. The collection of both child self-report and parent proxy reports when assessing HRQOL is recommended, and function needs to be assessed independently. Larger studies across the broader CP population, the design of CP specific HRQOL tools appropriate for use in the higher functioning CP cohort, and alternative better tolerated methods of investigating the motor system in children with movement disorders are recommended.

<p>Syftet med studien var att undersöka livskvaliteten hos barn och ungdomar med cerebral pares. 56 barn och ungdomar med cerebral pares i åldern 10-18 år med Gross Motor Function Classification system (GMFCS) tillhörighet I-III, som gick i grundskola, grundsärskola eller gymnasieskola och som erbjöds insatser från Skånes 11 olika barn- och ungdomshabiliteringar har undersökts via en enkät: Child Health Questionnaire (CHQ-87).</p><p>CHQ-87 är ett självskattningsformulär bestående av 87 frågor, indelade i två huvudområden som tillsammans täcker individens fysiska och psykosociala hälsa. Enkäten skickades ut per brev under våren 2008. Totalt skickade 167 enkäter ut och 56 enkäter inkom besvarade.</p><p>Resultatet visar ingen signifikant skillnad mellan den fysiska och den psykosociala hälsan. Skolsituationen och kamratrelationer upplevs positivt av flertalet som svarade och merparten svarar att de har det bra i sina familjer. De upplever att de har en god hälsa och att de inte oroar sig mera över sin hälsa än andra barn. Flera barn och ungdomar besväras av värk både ofta och mycket. Känslolivet upplevs stabilt, självkänslan är god och många upplever att de är glada och tillfreds med sig själva och sin kropp.</p> / <p>The aim of this study was to examine the quality of life in children and adolescents with cerebral palsy. 56 children and adolescents, diagnosed with cerebral palsy, ages 10-18, Gross Motor Function Classification System (GMFCS) level I-III, attending primary or secondary school in Sweden have been asked about their quality of life using a questionnaire, Child Health Questionnaire (CHQ-87). All children and adolescents have attended the 11 child habilitation centers in Skåne.</p><p>The CHQ-87 is self reported, and consists of two main domains of questioning, covering both the physical and psychological health of the individual.  A total of 167 questionnaires were sent out and 56 were returned and answered.</p><p>The results show no significant difference between the physical and psychological health.    The situation in school and having friends was highly ranked by most of the children and adolescents and many of them respond that they lead a good life within their families. They express that they are in good health and that they worry no more about their health than others. Many experience frequent and intense pain. They express a stable emotional life, good self esteem, happiness, and that they are satisfied with themselves and their own body.</p>