Age-related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy

Aim
The aim of this study was to use a prospective longitudinal study to describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP).

Method
Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4–16y) with CP. Ninety-four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty-seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment.

Results
Significant improvements in mean raw scores for GMFM, PEDI, and LAQ-CP were recorded; however, mean raw oxygen cost deteriorated over time. Age-related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (?lw=0.74–0.76).

Interpretation
These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.

E-Participation and E-Participants: solving the patent ‘crisis’

One of the major planks of some visions for E-Gov is that there is a willing participatory group who are more than happy to be involved in new forms of democracy and will be active and useful suppliers of input to e-consultation or e-participation processes. This group is different from that which goes online to the government site web and signs a petition asking the prime minister to resign. It is becoming clear, though, that the commitment to e-participation may well be there in theory, but difficult to access in practice. Further, the participation which is most welcome can frequently require training and expertise which is not widely available or there may be differences in opinion as to the point of participation. In this paper I will look to the attempts to encourage participation in the patent system. The UK is about to initiate a trial system utilising New York Law School’s Peer To Patent project, but has also attempted to involve participants in previous consultation exercises. I will use these as demonstrations of the sorts of problems which e-participation has met, and consider whether this new form of E-Gov is perhaps being oversold. The interesting question is whether participation is a growing tool which can ensure better public services from the State. My conclusion is that consultation and participatory projects can demonstrate involvement and are certainly educative but e-participatory projects are most likely incapable of achieving the goals set by their more optimistic advocates. The paper emphasises the patents field, but the lessons from it can – I suggest – be viewed as indicators having wider governance relevance. The primary point being made is that the technocratic view is always over-optimistic.

Democratic Participation, Engagement, and Freedom

It is commonly supposed that democracies should encourage greater political participation and civic engagement. This article identifies two distinct perspectives on political participation and civic engagement: a ‘freedom-centred’ model and an ‘ethical’ model. The ‘freedom-centred’ model defended here draws on the republican concept of freedom as non-domination, together with the political liberal notion of fair deliberative proceduralism, while the ethical model draws on Aristotelian, perfectionist, sources. It is argued that the ‘ethical’ model is overly concerned with the ‘moral renewal’ of modern social life, and is insensitive to problems of domination posed by its account of civic reciprocity and trust. By contrast, the ‘freedom-centred’ model developed offers a systematic account of personal and political freedom, which provides qualified support for deliberative modes of participation and engagement.

Social Participation and Maintaining Recommended Waist Circumference: Prospective Evidence From the English Longitudinal Study of Aging

Objectives: To investigate whether older adults participating in social activities are more likely to maintain or achieve recommended waist circumference (WC) levels. Method: A total of 4,280 older adults who participated in Wave 2 (baseline) and Wave 4 (follow-up) of the English Longitudinal Study of Ageing. WC was measured by a nurse in both study waves. Results: Participation in education, arts, music groups, evening classes, and in charitable associations was associated with maintaining recommended WC only in those men whose WC was in the recommended range at baseline. Participation in social activities was not associated with achieving recommended WC in women or men with initially large waist. Discussion: Participation in cultural and charitable activities may help in maintaining a recommended level of WC in older men with WC originally in the recommended range.