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Cervico-mandibular muscle activity in females with chronic cervical pain a descriptive, cross-sectional, correctional studyLang, Patricia January 2012 (has links)
Includes abstract. / Includes bibliographical references. / Chronic musculoskeletal conditions of the spine and periphery are a burden both internationally and in South Africa. There is a socio-economic burden as a consequence of the severity, duration and recurrence of chronic cervical musculoskeletal conditions among information technology and sedentary office workers. However, the precise mechanisms behind chronic cervical disorders remain unclear. It is theorised that the pathophysiological mechanisms in chronic cervical musculoskeletal conditions share a similar theoretical framework to chronic pain itself. The biopsychosocial model of chronic pain accepts the dynamic nature of pain. This model accepts the dual biological and psychosocial components that enhance the experience and maintenance of chronic pain, through central sensitisation. There appears to be a neurophysiological, biomechanical and psychological link between the cervical area and the temporomandibular area. Although numerous studies have implied that individuals with temporomandibular disorders have concurrent cervical dysfunction, there is currently no evidence that individuals with cervical dysfunction exhibit altered muscle activity in the masseter and cervical erector spinae muscles or report teeth clenching habits. Consequently, identification of factors that may contribute to chronic cervical musculoskeletal conditions, stemming from the temporomandibular area, may potentially be lost. The aim of the present study was to explore the activity levels of the cervicomandibular muscles in females with chronic cervical musculoskeletal conditions, who showed no symptoms of temporomandibular disorders. This study had a descriptive cross-sectional correlational design with single-blinding. The telephonic screening process was followed by the signing of informed consent forms. Validated questionnaires were used for categorisation and comparison of the socio-demographic and biopsychosocial profiles of the pain group (n = 20) and the no pain group (n = 22). The screening, informed consent and questionnaires were completed by an assistant. The first of five questionnaires, the adapted Research Diagnostic Criteria History questionnaire, was used as an instrument for exclusion of temporomandibular disorders and the recording of a daytime parafunctional teeth clenching habit. The remaining four questionnaires, listed as the Neck Disability Index, the Computer Usage Questionnaire, the Brief Pain Inventory, and the EuroQol-5D were used for determining levels of cervical disability for categorisation and comparison between groups, as well as for determining levels of pain-related disability, occupational and sporting activity, and health related quality of life.
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Efficacy of a peer-led exercise and education programme combined with a therapeutic relationship to manage pain in rural amaXhosa women living with HIV/AIDS compared to a therapeutic relationship aloneJackson, Kirsty Nontsikelelo January 2017 (has links)
Background: Pain is the one of the most prevalent symptoms in people living with Human Immunodeficiency Virus/Acquired Immune Disease Syndrome (HIV/AIDS) and is largely undermanaged. In urban amaXhosa women living with HIV/AIDS (LWHA), the 'Positive Living' (PL) programme has been identified as an effective non-pharmacological intervention for managing pain and may be affected by an empathetic therapeutic relationship. As a high prevalence of pain is likely to exist in rural amaXhosa women LWHA in South Africa, research is warranted on these two interventions amongst this population. Aim: To determine the effect of the combined PL programme and therapeutic relationship intervention (PL intervention), in comparison to a therapeutic relationship intervention (TR intervention) alone on pain severity, pain interference, symptoms of depression, health-related quality of life (HRQoL), self-efficacy and physical function in rural amaXhosa women LWHA. Method: A single-blind randomised trial was conducted using a sample of convenience. Interviewer administered questionnaires and functional tests at Baseline and at Weeks 4, 8, 12 and 24 were collected for the PL and TR intervention groups. Regression analysis determined the change of the primary outcomes, pain severity and interference, and secondary outcomes over the 24 weeks of the study. Results: Forty-nine amaXhosa women LWHA participated in the study. The PL programme and the data collection points were poorly attended by both groups. The pain severity and pain interference scores improved significantly in the PL (n = 26) and TR (n = 23) intervention groups over the 24 weeks of the study, with no significant differences between intervention groups. Symptoms of depression, HRQoL, self-efficacy and six of eight physical function tests were also significantly improved in the PL and TR intervention groups and, with the exception of self-efficacy, no significant differences existed between intervention groups. Conclusion: The therapeutic relationship appears to be sufficient to manage pain in rural amaXhosa women LWHA and should therefore be recognised as a necessary intervention to provide effective and adequate pain management.
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The relationship between motor proficiency, bilateral vestibular hypofunction and dynamic visual acuity in children with congenital or early acquired sensorineural hearing lossGeldenhuys, Wilhelmien January 2010 (has links)
Includes bibliographical references (leaves 105-115). / The functional integrity of the vestibular system in children is not often tested. Due to the close relationship between the cochlea and the peripheral vestibular system, the function of the vestibular system may be impaired in children with sensorineural hearing loss.The aims of this study were to determine the prevalence of impairments of motor performance, vestibular function and dynamic visual acuity, and the nature and extent of interaction between these in children between the ages of four and fourteen years with congenital and early acquired sensorineural hearing loss. Motor performance was evaluated by means of the Movement Assessment Battery for Children-2, dynamic visual acuity was determined by means of the Dynamic Visual Acuity Test, and vestibular function with the Southern California Postrotary Nystagmus Test.
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Proprioception, balance and lower limb strength in Nigerian children (7-10 years) with Generalized Joint Hypermobility and Developmental Coordination DisorderItuen, Oluwakemi Adebukola January 2016 (has links)
Background and justification: African children are reported as having a higher prevalence of generalised joint hypermobility (GJH) than their Caucasian counterparts. It is believed that abnormal joint biomechanics as a result of the joint laxity contribute to the damage of joints. The ability to perceive movement or position sense at joints (proprioception) is necessary for good postural control and motor performance. Sensory receptors carry information from the joints to the central nervous system for interpretation and appropriate motor response. Damage to these receptors or joint pain may have a negative effect on proprioception and motor control. A number of children with GJH also present with poor motor coordination and some may even have Developmental Coordination Disorder (DCD). Children with DCD and GJH also have similar functional difficulties. Both groups of children display difficulty in motor activities at school and home and are referred to as clumsy. There is evidence that poor motor coordination seen in children with DCD may be as a result of their inability to adequately control their flexible joints during movement. The role proprioception, balance and muscle strength plays in the relationship between GJH and DCD is still not clear. Aims and objectives: The main aim of this study was to determine whether proprioception, standing balance and strength in the lower limbs was different between children with GJH and children with normal joint mobility (NM). The specific objectives were to firstly identify the prevalence of GJH in a sample of Nigerian children and determine whether age and gender are related with the prevalence of GJH. Secondly, to determine whether having DCD or not was associated with differences in performance on these measures in children with and without GJH.
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The impact of physical movement disability amongst homeless adults in the Wynberg Haven Night ShelterMji, Gubela January 2001 (has links)
Bibliography: leaves 196-200. / The purpose of this study was to explore the impact of physical movement disability amongst adult homeless persons in the Wynberg Haven Night Shelter and secondly to make recommendations with regard to their needs that have been identified by the study. A cross sectional exploratory descriptive study was done using both qualitative and quantitive methods of data collection elucidating triangulation to validate data.
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A comparison of treatment protocols for infants with motor delayOlivier, Odette January 2012 (has links)
Purpose: Early intervention (EI) strategies are reported to have positive results on decreasing the extent of motor delay in children. However, most studies regarding treatment of infants with motor delay as a result of psychosocial/environmental factors have taken place in developed countries where resource constraints are not as severe as in the South African context. The aim was thus to determine which intervention protocol (standard vs. intense group orientated therapy) was the most feasible and efficacious for infants with motor delay, primarily due to psychosocial/environmental factors. Methodology: A cross sectional, descriptive, correlational research approach was used to identify infants with motor delay using the Bayley Infant Neurodevelopmental Screener III (BINS) at three Well Baby clinics. After a baseline assessment, infants who met the criteria to participate entered an experimental study consisting of a single blinded randomized control trial. The final sample included 24 infants aged 3 to 12 months. Participants were randomly divided into two groups and a repeated measures design was followed to conduct this study. The Bayley Scales of Infant Development II (BSID II) was used to evaluate motor progress over a three month intervention period. The standard group received treatment once a month for three months compared to a weekly treatment session attended by dyads in the intense group. Care-giver compliance along with their level of satisfaction was investigated using self-structured questionnaires. Results: Twenty four participants were recruited with a mean age of 5.69 months (SD= 2.36; range 3-10.4). Both monthly and weekly treatment groups showed significant motor developmental progress over the intervention period. The overall difference between the groups was not significant (p=.78) and by the final assessment, during the intervention period, both groups displayed similar psychomotor developmental indices (monthly: mean= 87.92, SD= 10.87, range 73-109; weekly: mean= 94.18, SD= 7.63, range 85-109). However there was a medium to large effect size ( d = 0.65) in favour of the weekly treatment group and they also showed better initial developmental progress after 1 month compared to the gradual trend of progress illustrated by the monthly group. After treatment sessions were withheld for six weeks, an assessment of motor performance showed the monthly group retained their skills better than the weekly group. This difference had a medium effect size of d = 0.58 in favour of the monthly group. Care-givers generally showed a high level of satisfaction with no significant differences between groups (p= .64). Similarly, no statistically significant difference was found between the groups in terms of compliance to the home programme. Conclusion: Both the intense and standard group orientated treatment protocols had significantly positive results after treatment. The intense group showed rapid initial progress compared to the monthly group. However, the monthly group better retained their skills after treatment was discontinued. Therefore, in a South African, low socio-economic context, the monthly protocol might be more practical and cost effective.
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The effects of scapulothoracic rehabilitation on shoulder pain in competitive swimmers Megan Dutton.Dutton, Megan January 2012 (has links)
Includes abstract. / Includes bibliographical references. / Competitive swimmers have a high incidence of shoulder pain. Secondary shoulder impingement is thought to be primarily responsible for shoulder pain in competitive swimmers. The effective management of shoulder impingement has been widely investigated; however there is minimal consensus on the optimal method of treatment and rehabilitation of shoulder impingement. In addition, current research does not adequately consider the role of scapulothoracic rehabilitation in the management of shoulder impingement. Aim: To determine the effects of a scapulothoracic rehabilitation programme on shoulder pain in competitive swimmers.
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The use of the EQ-5D-Y health related quality of life instrument in children in the Western Cape, South Africa: Psychometric properties, feasibility and usefulnessScott, Desiree Jean January 2015 (has links)
Includes bibliographical references / Aim: The overall aim of the study was to investigate the performance of the EQ-5D-Y, a self-reported Health Related Quality of Life (HRQoL) outcome measure, in children between eight and twelve years of age. The study objectives were to examine the measure's psychometric properties of criterion validity, discriminant and concurrent validity, when used on children with different health statuses, and to determine its ability to detect change within the different groups over a period of time. The study also set out to determine whether a life event had an impact on HRQoL, and whether children and their therapists or parents shared the same perceptions of HRQoL. The feasibility of using the EQ-5D-Y as a routine, additional, physiotherapy assessment tool was monitored. The study also assessed the usefulness of the collected data to the therapists administering the measure to children under their management. Method: A longitudinal, analytical descriptive study design was used. Typically developing children attending a Main Stream (MS) school (105), children with lifelong physical disabilities at a Special School (SS) (35), chronically ill children at an institution (CI) (32) and acutely ill children in hospital (AI) (52) were recruited. The EQ-5D-Y was the primary outcome measure, and was administered at baseline and again at three monthly intervals, or, in the case of AI children, at admission and discharge. The PedsQL as a parallel HRQoL measure, the WeeFim as a functional measure and the Faces Pain Scale (FPS) to monitor pain were used. A self-designed questionnaire was completed by the therapists treating the children to assess feasibility and usefulness of the EQ-5D-Y. Data analysis: Descriptive statistics were used to describe the sample and the health conditions of the participants. Reliability of the measures was determined at different time intervals by Cohen's kappa coefficient for dimension scores. Spearman's rho and Intraclass Correlation (ICC) were used to determine reliability of Visual Analogue Scale (VAS) scores and also total scores of the measures over time. The same analysis was used to compare self-reports and proxy reports. Kruskal-Wallis ANOVA by ranks, median scores and mean rankings were used to examine discriminant validity between known groups, using the same outcome measure and convergent validity between similar dimensions on different outcome measures. Responsiveness was described by examining the effect size of the Wilcoxon Signed-rank test. The VAS score was compared against the ranking of different levels of the dimensions, across groups, using Kruskal-Wallis H statistic. A discrepancy between changes in VAS and changes in Worried, Sad or Unhappy (WSU) dimension were examined after three months to determine whether these were related to life events and/or changes in management of health condition. The clinical feasibility of using the EQ-5D-Y and its usefulness as an additional evaluation tool in providing a holistic assessment of the child's condition was established by analysing the frequency of positive responses on the questionnaire. Results: A total of 224 children were recruited. The level of problems on the dimensions was associated with institution and in all cases, apart from Mobility, the AI children reported more problems. The EQ-5D-Y only demonstrated discriminant validity between the MS children and AI children. The MS group scored significantly lower ranked scores on all dimensions and a significantly higher VAS (better overall HRQoL) compared to the AI group with more problems on each dimension and lower VAS. When comparing VAS across the mean ranking on each dimension, it was found to be significantly correlated at the AI only. Convergent validity between EQ-5D-Y and PedsQL was evident only at the AI for all similar dimensions. The other groups demonstrated convergent validity with some, but not all of the dimensions. Convergent validity was evident between the EQ-5D-Y VAS and total scores of PedsQL and WeeFim (p<.05 in all cases) across institutions. The treatment effect over time was largest in the AI. For all groups, there was limited agreement between proxy and self-report at a dimension level, except for Mobility with moderate to good agreement. Even though the proxy and self-report VAS scores demonstrated good (.58) ICC overall, at an institutional level, this was only significant in the MS children. The EQ-5D-Y only took five minutes to complete. Six of the nine therapists who took part in the study, found the measure easy to apply, used the information in the management of the child and would continue to use it in future. Conclusion: The performance of the EQ-5D-Y, as determined by the psychometric properties, was variable. It could discriminate between children with an acute illness and children in the MS school. In addition, good convergent validity was demonstrated in the AI children and the largest treatment effect was observed in these children. However, it does not perform as well in children with no health condition or chronic conditions and should be used with caution in these groups. HRQoL did not appear to be linked to a life event. It is recommended that both proxy and self-report measures be taken into account when assessing a child's HRQoL but these should not be used interchangeably. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments. It was concluded that the EQ-5D-Y self-report can be used with confidence as an outcome measure for acutely-ill children.
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The association between prematurity, motor fuction and health related quality of life among learners in the foundation primary phaseOosthuizen, Henriëtte January 2017 (has links)
Introduction and Aims: Children born prematurely (≤ 36 weeks gestation) are at risk of poor developmental outcomes and are more likely than their full-term (FT) peers to have behavioural, physical and/or cognitive limitations. In order to deliver effective interventions, therapists need to have a sound understanding of the problems experienced by children who were born prematurely. Presently, very little is known about the functional problems of young school aged children, living in the Free State province of South Africa, who were born prematurely. Methodology: This study was conducted in 15 randomly selected schools located within in a 100 km radius of Bloemfontein. Two groups of children in grades R, 1 and 2 (age range: 5-8 years) were recruited, the first group (PREM group) consisted of children having a history of premature birth (≤ 36 weeks). The second group consisted of full term children (FT group) who were matched for age and gender to the first group. The PREM group was categorised into three subgroups according to prematurity status: late premature (34-36 weeks, LP), moderate (MP) to very premature (29-33 weeks, VP) and extremely premature (≤ 28 weeks, EP). A self-designed questionnaire was used to record demographic and medical information obtained from parents. The questions were related to antenatal factors, birth and medical history of the child. The Movement Assessment Battery for Children second edition (MABC-2) and MABC-2 Checklist were used to evaluate functional motor problems in children. The European Quality of Life Dimension Scale- Youth version (EQ-5D-Y) was used to determine the Health Related Quality of Life of the children and the Strengths and Difficulties Questionnaire (SDQ) was used to describe the behavioural and emotional status of each child according to their parents and teachers. Ethical approval was obtained from the University of Cape Town Research Ethics Committee (HREC REF: 694/2014) and permission to conduct the study within schools was granted by the Free State Education Department. Informed consent and assent was obtained. Parents were interviewed by a research assistant using the self-designed questionnaire. A different researcher then tested all children using the MABC-2 and assisted each child to complete the EQ-5D-Y. The parents and teachers each completed the SDQ and teachers completed the MABC-2 checklist. Statistical analysis was conducted using SAS® Version 9.4 and STATISTICA 10. The data were summarized using descriptive statistics (i.e. number of available data (n), mean, and standard deviation, minimum, median and maximum). The Mann Whitney U test was used to compare groups (PREM vs FT groups) and the Chi-square test was used to determine any association between groups and 5 descriptive variables. Comparisons between prematurity subgroups were conducted using the Kruskal- Wallis ANOVA. Results: 122 children participated in this study: 61 FT children and 61 PREM children. The PREM group consisted of 23 children who were classified as late premature, 27 who were moderate to very premature and 11 children who were extremely premature There were no differences between groups in terms of age (U = 1760, z = -0.51, p = 0.610), gender (Chi = 0.03, df = 2, p = 0.86), grade level (Chi = 0.386, df = 3, p = 0.98) and socioeconomic status [as defined by mothers level of education (Chi = 3.79, df = 2, p = 0.15) and school quintile (Chi = 5.22, df =2, p = 0.07)]. Differences were found in terms of maternal age at delivery (PREM = 31.9 years [SD=5.2] vs. FT = 29.02 years [SD = 3.5] df = 120, t = -3.61, p < 0.001). As expected, the PREM group had a significantly lower birthweight compared to the FT group (PREM = 2201g [SD = 748] vs. FT = 3132g [SD = 406], df = 120, t = 8.54, p < 0.001). 96.7% of those in the PREM group were born via C/section (p < 0.0001). Apart from one case of respiratory distress, the FT group reported no neonatal complications. As expected, more candidates in the PREM group were more frequently hospitalised (Chi = 34.605, df = 2), and cases of CP were reported. The APGAR scores were significantly different between FT and PREM groups at 1min (p<0.0001) and 5min (p<0.0001) Regarding motor performance, there was a significant difference in MABC-2 Total Standard Scores (MABC TSS) (U = 1425.0, z = 2.23, p = 0.026) and the MABC-Checklist Total Motor Scores (U = 1016.5, z = -4.32, p < 0.0001) with FT group performing better and reporting less functional motor problems than the PREM group. Regarding HRQoL, we found that groups were also significantly different in terms of the Mobility domain of the EQ-5D-Y with the Prem group reporting more problems than the FT group (Chi = 6.31, df =1, p = 0.012). No differences were found between groups with regard to the Looking After Myself (Chi = 2.03, df =1, p = 0.153), Usual Activities (Chi = 0.00, df = 1, p = 1.0), Worried/Sad/Unhappy (Chi = 1.22, df =1, p = 0.541), and Pain/Discomfort (Chi = 3.59, df = 1, p = 0.165) domains. In terms of emotional-behavioural status, we found no differences between the two groups in terms of Parent Total Difficulties scores (U = 1791.50, z = -0.351, p = 0.725) as well as Teachers Total Difficulties Scores (U = 1518.0, z = -1.751, p = 0.08). However, the FT group scored lower than the PREM group on the emotional domain (U = 1404.0, z = -2.33, p = 0.02) indicating less problems and higher on the prosocial domain (U = 1335.0, z = 2.68, p = 0.007) indicating more positive factors in this group. On examination of the PREM sub groups, we found no differences in Parent Total Difficulties Score between groups (p = 0.377). When we compared parent versus teacher SDQ scores, 45 (73.8 %) cases where the parent and teacher were in agreement with the "normal" assigned score. In addition, there were 2 (3.3 %) cases were the parent and teacher respectively assigned a score of "abnormal" and "borderline". Regarding the Impact scores, parents/caregivers reported that the difficulties (emotional, conduct, hyperactivity, peer and prosocial problems) did not have an impact on a child's friendship (p = 0.2889), classroom learning (p = 0.2325), leisure activities (p = 0.3585) or their home life (p = 0.1248). In contrast, teachers' responses indicated that the difficulties had an influence on classroom learning (p = 0.0030) but not friendships (p = 0.2374). Discussion: The late premature group made up a bigger proportion of the premature group. This correlates with the PPIP report, where the same trend was noted for the South African premature population (Pattinson, Saving Babies [PPIP], 2012-2013; Kalimba & Ballot, 2013). Findings from this study correlated with literature on PREM children being more at risk of decreased motor function when compared to FT peers (Hack et al., 2002; Chyi et al., 2008; Stephans & Vohr, 2009; Van Baar et al., 2009; Hornby & Woodward, 2009; Van Baar et al, 2013). Fine motor skills is essential in a child's daily activities and very important to function at school. This study indicated a deficiency within fine motor and balance domains within the PREM group. Maternal age surfaced as predictor of motor performance as younger mothers (< 19 years) have an increased risk of low birth weight and premature infants (very and extremely premature) (Schempf, Branum, Lukacs & Schoendorf, 2007; Gibbs, Wendt, Peters & Hogue, 2012; Kalimba & Ballot, 2013; Fall, Sachdev, Osmond, Restrepo-Mendez, Victora, Martorell, Stein, Sinha, et al., 2015; Benli, Benli, Usta, Atakul, Koroglu, 2015). Literature on older mothers (≥ age 35) also showed an increased risk towards premature birth (moderate and very premature) with more medical conditions (such as hypertension and diabetes)-this was not the case in this research (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015), however it is reported that PREM infants from older mothers show somewhat better outcomes of infants later in life (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015). Other findings from this research indicated that, from the teachers' perspectives, PREM children showed a greater tendency towards emotional and prosocial behaviour impairments, than the FT population. This align with literature where premature infants are mentioned to be more susceptible to behaviour performance problems at school-age (Kerstjens et al., 2012; Bos et al., 2013; Moreira et al., 7 2014). In this research, the extremely premature group had more behavioural problems which had an impact on theses children's leisure activities, peer, and classroom learning. Conclusion: Our findings suggest that PREM children have more motor problems than FT children and that the very preterm group showed the highest risk for motor problems. Maternal age also indicated to be an influencing factor where mothers younger than 19, as well as mother over 35, both indicated a risk for premature birth, resulting in low birth weight. Other risk factors influencing function in the PREM, apart from low birth weight, indicated by the results were factors like respiratory distress, apnoea, haemorrhaging and the exposure to post-natal steroids. According to teacher's perceptions, the children in the PREM group, tended to show more behavioural and emotional problems that those of the FT sample.
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Factors associated with improvement in the gross motor function outcomes of children with acquired brain injury in a paediatric intermediate care facility in the Western Cape, South Africa: A descriptive studyAchmat, Faiza 18 February 2019 (has links)
Aim: The study aimed to record the recovery patterns of gross motor function following acquired brain injury (ABI) in 17 participants, aged two to 14 years, receiving physiotherapy intervention at a paediatric intermediate care facility in the Western Cape, South Africa. Objectives of the study were to explore if factors such as age at injury, time since injury, intervention type, injury severity, gender, and the health- related quality of life of the child and caregiver were predictive of improvement of motor function and participation. Methods: A quantitative, longitudinal, prospective cohort design with repeated measures was employed. The children received physiotherapy either intensively or intermittently within eight months post brain insult. The Gross Motor Function Classification System (GMFCS) was used to classify the children according to their functional abilities. The Gross Motor Function Measure 88 (GMFM88) was used to assess changes in the child’s gross motor function. The Paediatric Evaluation of Disability Inventory (PEDI) evaluated functional performance in daily life activities (participation). The EQ-5D-Y proxy version and the Caregiver Strain Index (CSI) evaluated the health-related quality of life of the children and caregivers respectively. Assessments were performed at Baseline, Week 3, 7, 9 and 13 after admission to the study. Analysis: Descriptive statistics were used to describe the demographic data of the participants. Non-parametric analysis was performed to determine the time points at which the greatest improvement occurred because the sample was relatively small to support an adequately powered randomized intermittent trial. The GMFM88 was the primary outcome measure and the changes in score over the 13-week study period were plotted graphically in an attempt to identify patterns of improvement. The change in score from Baseline to Week 3 was also used as the dependent variable in investigating the determinants of short term improvement between the five measurement time points. Scatterplots and Spearman’s rho were used to investigate the relationship between changes in GMFM88 score from Baseline to Week 3 and the age of the child at injury, time from injury and Baseline GMFM88 score. The Kruskal Wallis ANOVA for ordinal data was used to establish whether there were differences in all the outcome measures at the different time points: between Baseline and Week 3, between Week 3 and Week 7 and between Week 7 and Week 9 and, if significant, a post-hoc Sign test was done to see where the differences lay. The effect size was calculated by dividing the z value by the square root of the total number of observations at both time points. Simple regression analysis was used to determine the variance in Week 9 GMFM88% score accounted for by the Baseline score. Results: Seventeen participants met the inclusion criteria and were recruited. There were more boys (n=14) than girls (n=3) admitted with brain injury and the majority of the total sample (n=14) were drawn from families with minimal financial resources. Although no differences were found between the two intervention groups, the greatest improvement in GMFM88 scores was observed within the first three weeks of intervention, regardless of the time since injury. Three patterns of recovery were identified through plotting the GMFM88 scores: Group A, included participants with a high baseline score who showed sustained but small improvement until reaching the ceiling score; Group B, participants who started with lower scores and then improved considerably; and Group C, participants who started with low scores and showed slower and smaller improvement. Most participants (n=13) returned to near normal motor function after Week 9 (over 90% on the GMFM). Four participants did not show the same improvement: The Week 9 GMFM88 score was less than 60% in one participant and less than 30% for the other three. In this study, participants who showed the greatest improvement were those children on GMFCS levels three and four. The Baseline GMFM88 scores were significantly correlated with other time points (rho=0.886 at Week 9 and 0.748 at Week 13), but not with the change in scores. The effect size of the change in GMFM88 scores from one time point to the other were all measured as medium (effect size of 0.5 but less than 1.3) and the largest effect size was seen between Baseline and Week 7 (effect size=.660). Change in score from Baseline to Week 3 was not predicted by gender, cause of injury or method of intervention delivered (intensive or intermittent). The Baseline motor score accounted for 86% of the variance of the Week 9 GMFM88% score and each point in the baseline score increased the Week 9 score by .94. The PEDI Mobility Score demonstrated a similar pattern of improvement to the GMFM88, but the pattern in progression of the PEDI Self-care domain was less clear. The EQ-5D-Y Proxies indicated that at Week 13, at least five children still had problems in one or more of the dimensions, with the greatest number (n=-8) having problems with the Usual Activities and Worried, Sad, or Unhappy domains. The older (above age nine years), higher functioning children made less gains in their functional abilities. The greatest cumulative cause of strain reported by the thirteen respondents, was a change in the former self of the child, followed closely by financial strain and work adjustments. The caregivers of the children in Group C, the most disabled group, experienced double the strain at Week 13 than caregivers of children with mild and moderate brain injury. Although not correlated at Baseline, the CSI was negatively correlated with the proxy EQ-5D-Y reported visual analogue general health scale at Week 13 (n=10, rho=-724, p=.018) .655, p=.021). Conclusions: Although, most participants in the study regained physical functioning, approximately 25% admitted for rehabilitation with ABI might have significant residual motor damage and require on-going rehabilitative support. Although there were no other factors identified which predicted the outcome, these children could be identified based on poor GMFM88 scores on admission to rehabilitation. The EQ-5D-Y indicated that at Week 13, eight of the 12 proxies reported that participants had problems with anxiety and depression. Rehabilitation might therefore need to include a greater emphasis on self-care and mental health of the child, even when motor control has been established. Planning of long-term support should start early to maximise recovery and reduce the stress on caregivers. The study findings cannot be generalised due to the small sample size, but the results should alert therapists at the Facility to the possible long-term outcomes of children admitted with ABI. The study findings can assist with the formulation of patient specific and family centred rehabilitation care plans for children admitted with ABI at the Facility.
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