The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome

This study was a trial of an intervention programme aimed to improve parental self-efficacy in the management of problem behaviours associated with Asperger syndrome. The intervention was compared across two formats, a I day workshop and six individual sessions, and also with a non-intervention control group. The results indicated that, compared with the control group, parents in both intervention groups reported fewer problem behaviours and increased self-efficacy following the interventions, at both 4 weeks and 3 months follow-up. The results also showed a difference in self-efficacy between mothers and fathers, with mothers reporting a significantly greater increase in self-efficacy following intervention than fathers. There was no significant difference between the workshop format and the individual sessions.

Postural control and movement performance during upper limb tasks in children with developmental co-ordination disorder (DCD)

At least 6% of primary school aged children present with DCD, where co-ordination is substantially below the normal range for the child’s age and intelligence. Motor skill difficulties negatively affect academic achievement, recreation and activities of daily living. Poor upper-limb co-ordination is a common difficulty for children with DCD. A possible cause of this problem is deviant muscle timing in proximal muscle groups, which results in poor postural and movement control. While studies have been published investigating postural control in response to external perturbations, detail about postural muscle activity during voluntary movement is limited even in children with normal motor development. No studies have investigated the relationship between muscle timing, resultant arm motion and upper-limb coordination deficits. Objectives: To investigate the relationship between functional difficulties with upper-limb motor skills and neuromuscular components of postural stability and coordination. Specifically, to investigate onset-timing of muscle activity, timing of arm movement, and resultant three-dimensional (3D) arm co-ordination during rapid, voluntary arm movement and to analyse differences arising due to the presence of DCD. This study is part of a larger research program investigating postural stability and control of upper limb movement in children. Design: A controlled, cross-sectional study of differences between children with and without DCD. Methods: This study included 50 children aged eight to 10 years (25 with DCD and 25 without DCD). Children participated in assessment of motor skills according to the Movement ABC Test and a laboratory study of rapid, voluntary arm movements. Parameters investigated included muscle activation timing of shoulder and trunk muscles (surface electromyography), arm movement timing (light sensor) and resultant 3D arm motion (Fastrak). Results: A MANOVA is being used to analyse between-group differences. Preliminary results indicate children with DCD demonstrate altered muscle timing during a rapid arm raise when compared with the control group of children. Conclusion: Differences in proximal muscle timing in children with DCD support the hypothesis that altered proximal muscle activity may contribute to poor proximal stability and consequently poor arm movement control. This has implications for clinical physiotherapy.

Surgical programme at Royal Alexandra Hospital, Sydney, for Papua New Guinea children with congenital heart disease, 1978-1994

Objective : To report the history of the Royal Alexandra Hospital for Children (RAHC) Papua New Guinea (PNG) cardiac surgical programme and describe the selection, preoperative clinical features and postoperative outcome of children with congenital heart disease managed by the programme. Methods : Details for each of the PNG cardiac patients admitted to RAHC following selection by visiting cardiologists between 1978 and 1994 were entered into a database, and analysed and interpreted. Results : A congenital heart defect was confirmed in 165 of the 170 children selected. The male to female ratio was 1:1 and the mean age on admission to RAHC was 5.5 years. Almost all of the children for whom data were available (98%) had a weight for age and 41% had a height for age less than the 3rd centile. One-sixth had delayed milestones. A large number were tachypnoeic, in heart failure, or had pulmonary hypertension on admission. Ventricular septal defect and tetralogy of Fallot were the commonest defects, and lesions such as aortic stenosis, coarctation of the aorta and transposition of the great arteries were absent or rare. Thirty-one (19%) of the children selected initially did not receive surgery because of pulmonary hypertension, or because the lesions did not fall within the programme guidelines for operation. One hundred and twenty-nine children had corrective and four had palliative procedures. Half of the operated children had postoperative complications. Eight children died, all following open-heart procedures, giving a case fatality rate of 6%. Preoperative tachypnoea, hepatomegaly, cardiac failure and pulmonary hypertension were strongly associated with poor outcome. Conclusions : The programme was an arduous exercise for all organizations concerned, but achieved comparatively good short-term outcomes. The experience gained should assist in planning for similar programmes.

Play Preferences and Behavior of Preschool Children with Autistic Spectrum Disorder in the Clinical Environment

The play of children with autistic spectrum disorder (ASD) is a valuable medium for assessment and intervention, and its analysis has the potential to aid diagnosis. This study investigated spontaneous play behavior and play object preferences for 24 preschool children with ASD in a typical occupational therapy clinical environment. Play behavior was rated and choice of play object noted at 10-second intervals from a 15-minute video recording of unstructured play. Statistical analyses indicated that play behavior was consistent with descriptions in the literature. In addition, the children demonstrated clear preferences for play objects in the form of popular characters (e.g., Thomas the Tank Engine) and those with sensorimotor properties. We propose that the inclusion of preferred play objects in a clinical environment may increase intrinsic motivation to play, and thereby enhance assessment and intervention.

Rites of passage: Understanding participation of children with developmental coordination disorder

Children with developmental coordination disorder (DCD) experience difficulty participating in the typical activities of childhood and are known to have a more sedentary pattern of activities than their peers. Little research has been done to investigate the impact of these deficits on the lives of children with DCD and the importance of their participation in the typical activities of childhood. This qualitative study explored the impact of the disorder and the importance of participation for children with DCD from the perspective of the parent. Twelve in-depth interviews were conducted with parents of children with DCD who attended a university clinic specializing in using the Cognitive Orientation to daily Occupational Performance (COOP) approach, a cognitive-based intervention. Findings revealed that incompetence in everyday activities had serious negative effects for the children. Conversely, intervention that was focused on enablement at the activity and participation level had a significant positive impact on the children's quality of life. Emerging themes highlighted the notion that performance competency played an important role in being accepted by peers and being able to be part of the group. As well, parents reported that successful participation built confidence in their children and allowed them to try other new activities. The World Health Organization's International Classification of Functioning, Disability, and Health provides a unique framework for analyzing and understanding the impact of the physical disability on the lives of families with children with DCD. Results illustrate how intervention that focuses on enabling children to choose their own functional goals in the area of physical activity has important implications for enabling participation and building the social networks of children with DCD. (C) 2003 Elsevier B.V. All rights reserved.

Motor and functional skills of children with developmental coordination disorder: A pilot investigation of measurement issues

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Pea-body Developmental Motor Scales (fine motor total score) (M = 85.65, SD = 12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M = 96.15, SD = 10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M = 49.98, SD = 16.62) and mobility function (M = 54.71, SD = 3.99), however, self-care function was below the average range for age (M = 38.01, SD = 12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed. (C) 2003 Elsevier B.V. All rights reserved.

Resting energy expenditure and body composition in children with myelomeningocele

Purpose : Myelomeningocele is a complex disease often complicated by obesity for reasons not well understood. The objectives of this study were to determine body composition and energy expenditure of children with MMC. Methods : Resting energy expenditure (REE), body composition and anthropometry were measured in 19 children with MMC (12 M, 7 F). Total energy expenditure (TEE) was estimated using a 3-day activity record. Energy intake (EI) was measured in seven children (5 M, 2 F) with MMC. Data were then compared with predicted values. Results : Mean REE ( n = 19) was 4680 ±1452 kJ/day (96.1 ±18.1% of predicted REE). The range was large (45.8-125.7% of predicted REE). TEE ( n = 7) was 4344 ±2376 kJ/day, hence only 73 34% of predicted TEE. EI ( n = 7) was 6560 ±1329 kJ/day, approximating a normal energy requirement. Overall, BCM was lower than expected values. Conclusions : REE in children with MMC is variable when compared to predicted values. TEE was found to be lower in children with MMC than predicted values and EI was similar to predicted values in this group of seven children. BCM is reduced in children with MMC when compared to expected values.

Measured and predicted total body water in children with myelomeningocele

Objective: Children with myelomeningocele (MMC) have an altered body composition and an atypical distribution of total body water (TBW). The aim of the present study was to determine the accuracy of current predictive equations, based on bioelectrical impedance analysis (BIA), in determining TBW when compared with measured TBW using deuterium dilution. Methods: Fourteen children with MMC were measured for whole body BIA and TBW (using deuterium dilution and the Plateau method). Total body water was predicted using equations based on the resistance and characteristic frequency from BIA measurements and heights of subjects. Results: The mean measured TBW was 15.46 +/- 8.28 L and the mean predictions for TBW using equations based on the resistance and characteristic frequency from BIA measurements and heights of subjects were 18.29 +/- 8.41 L, 17.72 +/- 11.42 L and 12.51 +/- 7.59 L, respectively. The best correlation was found using characteristic frequency. The limits of agreement between measured and predicted TBW values using Bland-Altman analysis were large. Conclusions: The present study suggests that the prediction of TBW in children with MMC can be made accurately using the equation of Cornish et al . based on BIA measurements of characteristic frequency.

EMA analysis of tongue function in children with dysarthria following traumatic brain injury

Primary objective : To investigate the speed and accuracy of tongue movements exhibited by a sample of children with dysarthria following severe traumatic brain injury (TBI) during speech using electromagnetic articulography (EMA). Methods and procedures : Four children, aged between 12.75-17.17 years with dysarthria following TBI, were assessed using the AG-100 electromagnetic articulography system (Carstens Medizinelektronik). The movement trajectories of receiver coils affixed to each child's tongue were examined during consonant productions, together with a range of quantitative kinematic parameters. The children's results were individually compared against the mean values obtained by a group of eight control children (mean age of 14.67 years, SD 1.60). Main outcomes and results : All four TBI children were perceived to exhibit reduced rates of speech and increased word durations. Objective EMA analysis revealed that two of the TBI children exhibited significantly longer consonant durations compared to the control group, resulting from different underlying mechanisms relating to speed generation capabilities and distances travelled. The other two TBI children did not exhibit increased initial consonant movement durations, suggesting that the vowels and/or final consonants may have been contributing to the increased word durations. Conclusions and clinical implications : The finding of different underlying articulatory kinematic profiles has important implications for the treatment of speech rate disturbances in children with dysarthria following TBI.

Atuando em contexto : o processo de avaliação numa perspectiva inclusiva

Para que a diversidade possa se fazer presente, a base da educação de alunos com necessidade educativas especiais (n.e.e.) precisa se construir numa abordagem de apoio colaborativo. Neste relato buscamos evidenciar o processo de repensar a avaliação educacional de um aluno da segunda série. A partir do trabalho com a professora e a pedagoga, definimos aspectos a serem avaliados e um projeto educativo para o aluno a ser trabalhado na sala de aula. O estudo deste caso desencadeou uma atitude de mudança quanto à avaliação nos profissionais das séries iniciais, trazendo à tona inúmeras questões sobre o processo de avaliação naquela escola. Os dados nos mostraram a processualidade do trabalho e como é difícil passar de uma avaliação diagnóstica por especialistas para uma avaliação pedagógica das condições de ensino-aprendizagem.

O aluno com deficiência motora e a acessibilidade arquitectónica no Ensino Básico : um estudo de caso : o concelho de Guimarães

RESUMO:Para que o sucesso educativo se verifique, a escola tem de ajustar a sua prática educativa a todos os alunos, incluindo os que apresentam necessidades educativas especiais (NEE). Portugal dispõe de legislação que assegura o direito à educação e à igualdade de oportunidades, consignados na Constituição da República Portuguesa (artigos 71º, 73º e 74º), em consonância com a Declaração Universal dos Direitos do Homem e na Lei de Bases do Sistema Educativo (artigos 2º, 7º, 17º e 18º). O nosso país subscreveu também a Declaração de Salamanca, a qual reuniu, em 1994, o consenso de noventa e dois governos e de vinte e cinco organizações internacionais, reafirmando o direito à educação para todos. A construção da escola inclusiva passa pela responsabilização da escola por todos os alunos, na perspectiva de educação para todos, exigindo a sua concretização novas estratégias e resposta a novos desafios. Há que alterar práticas para atender à diversidade. Assim, as escolas precisam de estar arquitectonicamente adaptadas às necessidades dos alunos que utilizam a cadeira de rodas como forma de mobilidade, respeitando o direito à diferença e possibilitando, em igualdade de oportunidades, o sucesso escolar e educativo. Levar à prática as medidas previstas na lei portuguesa e implementar, em cada escola, a inclusão do aluno com mobilidade condicionada, implica equipar as escolas com adaptações, meios e recursos educativos facilitadores do seu processo ensino/aprendizagem. A constatação do que efectivamente acontece no terreno educativo no que concerne aos alunos com deficiência motora que usam a cadeira de rodas para se movimentarem assume toda a centralidade da nossa investigação, que tem o cariz de um estudo de caso. Incide sobre a compreensão mais aprofundada de como se processa o acesso arquitectónico nas escolas do Ensino Básico da Zona Norte e mais concretamente do Concelho de Guimarães. Recolhemos dados através de questionários dirigidos aos professores de apoio educativo e coordenadores de escola; ouvimos os alunos com deficiência motora pronunciar-se sobre as dificuldades que sentiam; observámos o seu quotidiano escolar e, finalmente, escutámos as entidades locais, através de uma entrevista realizada à Vereadora da Cultura do Concelho de Guimarães. Os resultados obtidos serão, como foi acordado, divulgados aos intervenientes com responsabilidades directas no campo da educação que se prontificaram a partilhar connosco a sua informação e saber, no sentido de os sensibilizar para a necessidade de rever o aspecto das acessibilidades arquitectónicas nas instituições educativas que servem o seu concelho, pois, como verificámos, muito há ainda a fazer para que o Ensino Básico, universal e obrigatório, se traduza numa igualdade de oportunidades de acesso e sucesso educativo para os alunos que utilizam a cadeira de rodas para se movimentarem no espaço escolar. ABSTRACT: For the educational success of a school it has to adjust its educational practice so that it includes those with special needs. According to the Portuguese law, disabled people have the right to education and equal opportunities, well expressed in the Constitution of the Portuguese Republic (articles 71st, 73rd, and 74th), in consonance with the Universal Declaration of Human Rights, and in the main law the educational system (articles 2nd, 7th, 17th and 18th). Our country has also subscribed the Declaration of Salamanca, which was written in 1994 with the agreement of Representatives from ninety-two governments and twenty-five International Organizations, where was reaffirmed the right of education for all. It is necessary that school increases its responsibility in what concerns the education of all its students. Educating all and every student demands new strategies to face new challenges and so some practices have to be changed to respond to diversity. Schools must be architecturally adapted to give the disabled students, who use a wheel chair, equal opportunities to achieve educational success. Taking the measures foreseen in Portuguese law into practice, and implementing in each school the inclusion of students with conditioned mobility, involves equipping schools with adaptations, equipment and educational resources that facilitate the teaching / learning process. The observation of what actually happens on educative ground, regarding to pupils with motor disabilities who use a wheelchair to move, assumes the centrality of our research, which is a case study. It focuses on the deeper understanding of the way the architectonic access in primary schools of the North, and more specifically the Municipality of Guimarães, is processed. We collected data through questionnaires addressed to educational support teachers and school coordinators; heard students with motor disabilities to comment on the difficulties they felt; observed their daily school life, and finally heard the local authorities, through an interview the Councillor of Culture of the Municipality of Guimarães. As agreed, the results will be communicated to intervenients with direct responsibilities in the field of education who were willing to share with us their information and knowledge in order to raise awareness of the need of looking over the aspect of architectural accessibility in educational institutions that serve their county, because, as noted, much remains to be done so that the basic education, universal and compulsory, will result in equality of educational opportunities in access and success for students who use a wheelchair to move in school space.