Self-reported quality of life of 8-12 year old children with cerebral palsy: a cross-sectional European Study

Background

Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population.

Methods

1174 children aged 8–12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population.

Findings

Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7·6, 95% CI 2·7–12·4); intellectual impairment with reduced mean for moods and emotions (3·7, 1·5–5·9) and autonomy (3·3, 0·9–5·7); and speech difficulties with reduced mean for relationships with parents (4·5, 1·9–7·1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible.

Interpretation

Parents can be reassured that most children aged 8–12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.

Vegetation history at the multi-period prehistoric complex at Ballynahatty, Co. Down, Northern Ireland.

Palaeoecological methods can provide an environmental context for archaeological sites, enabling the nature of past human activity to be explored from an indirect but alternative perspective. Through a palynological study of a small fen wetland located within the catchment of a multi-period prehistoric complex at Ballynahatty, Co. Down, Northern Ireland, we reconstruct the vegetation history of the area during the early prehistoric period. The pollen record reveals tentative evidence for Mesolithic activity in the area at 6410-6220 cal. BC, with woodland disturbance identified during the Mesolithic-Neolithic transitional period ca. 4430-3890 cal. BC. A more significant impact on the landscape is observed in the Early Neolithic from 3944-3702 cal. BC, with an opening up of the forests and the establishment of a mixed agricultural economy. This activity precedes and continues to be evident during the Mid-Neolithic during which megalithic tombs and related burial sites were constructed at Ballynahatty. Due to chronological uncertainties and a possible hiatus in peat accumulation in the fen, the contemporary environment of the Ballynahatty timber circle complex (constructed and used ca. 3080-2490 cal. BC) and henge (dating to the third millennium cal. BC) cannot certainly be established. Nevertheless, the pollen record suggests that the landscape remained open through to the Bronze Age, implying a long continuity of human activity in the area. These findings support the idea that the Ballynahatty prehistoric complex was the product of a gradual and repeated restructuring of the ritual and ceremonial landscape whose significance continued to be recognised throughout the early prehistoric period.

Microscopical evaluation of neural connectivity between paired stages of Eudiplozoon nipponicum (Monogenea : Diplozoidae)

Diplozoidae monogeneans are fish-gill ectoparasites comprising 2 individuals fused in so-called permanent copula. This unique situation occurs when 2 larvae (diporpae) make contact on the host gill, such that their union triggers maturation into an individual adult worm. The present study examined paired stages of Eudiplozoon nipponicum microscopically to ascertain whether somatic fusion involves neural connectivity between these 2 heterogenic larvae. Neuronal pathways were demonstrated in whole-mount preparations of the worm, using indirect immunocytochemical techniques interfaced with confocal scanning laser microscopy for peptidergic and serotoninergic innervations and enzyme cytochemical methodology and light microscopy for cholinergic components. Elements of the central nervous systems of paired worms are connected by commissures the region of fusion so that the 2 systems are in structural continuity. Interindividual connections were most apparent between corresponding ventral nerve cords. All 3 classes of neuronal mediators were identified throughout both central and peripheral connections of the 2 nervous systems. The anatomical complexity and apparent plasticity of the diplozoon nervous system suggest that it has a pivotal role not only in motility, feeding, and reproductive behaviors but also in the events of larval pairing and somatic fusion.

A multi-proxy palaeoenvironmental investigation of the findspot of an Iron Age bog body from Oldcroghan, Co. Offaly, Ireland

In 2003, the remains of an Early Iron Age bog body, known as ‘Oldcroghan Man’, were recovered during the cutting of a drainage ditch in a bog in the Irish Midlands. Only some fingernails and a withe fragment remained undisturbed in situ in the drain face, providing the sole evidence for the original position of the body. A detailed reconstruction of the depositional context of the body has been undertaken through multi-proxy analyses of a peat monolith collected at the findspot. The palynological record shows that the surrounding area was the focus of intensive human activity during the Later Bronze Age, but was largely abandoned during the Bronze Age–Iron transition in the mid-first millennium BC. In the mid-4th century BC, a bog pool developed at the site, evidenced in the stratigraphic, plant macrofossil, testate amoebae and coleopteran records. Plant macrofossil and pollen analysis of peat samples associated with the fingernails suggests that the body was deposited in this pool most likely during the 3rd century BC. The absence of carrion beetle fauna points to complete submergence of the body within the pool. Deposition occurred shortly before or around the time that the surrounding area again became the focus of woodland clearance, as seen in the extended pollen record from the peat monolith. This period corresponds to the Early Iron Age in Ireland, during which renewed cultural connections with Britain and continental Europe can be seen in the archaeological record and widespread forest clearance is recorded in pollen records from across Ireland. The palaeoenvironmental results indicate, therefore, that the demise of Oldcroghan Man took place at a pivotal time of socio-economic and perhaps political change.

Lifestyle limitations of children and young people with severe cerebral palsy: a population study protocol

Aim.  This paper is a presentation of a study protocol to establish the prevalence of orthopaedic problems (hip dislocation, pelvic obliquity, spinal deformity and contractures) and their impact on pain, function, participation and health in a population of children and young people with severe cerebral palsy.

Background.  Cerebral palsy is the commonest cause of motor impairment in childhood and is associated with life-long disability. An estimated 30% of people with cerebral palsy have severe forms and are non-ambulant. Although the underlying neurological damage is not amenable to correction, many health services are dedicated to providing therapeutic and adaptive support to help people with the condition reach their potential.

Method.  A cross-sectional survey of children and young people, aged 4–25 years with severe, non-ambulant cerebral palsy as defined using the Gross Motor Function Classification System (Levels IV and V). Study participants will be identified from a pre-existing, geographically defined case register and recruited via a healthcare professional known to them. Two assessments will be undertaken: one involving parents/carers at home and using questionnaires; the other involving the child/young person ideally in one of three settings and including X-rays if clinically indicated.

Discussion.  This study will contribute to our knowledge of the history and epidemiology of orthopaedic problems in children and young people with cerebral palsy and how these problems accumulate and impact on participation, health and well-being. The study will also identify unmet need and make recommendations for good practice in relation to the orthopaedic care and management for people with severe cerebral palsy

Common psychology problems in cerebral palsy

Cerebral palsy (CP) refers to a collection of motor impairments which result in abnormal posture and movement following an insult or damage to the developing brain. Psychological adjustment in children with CP is under researched with little population-based or longitudinal data, but there is sufficient evidence to suggest that children with CP are at increased risk for psychological problems. The types of difficulties they experience include emotional, hyperactivity and peer problems with conduct disorder being more prevalent in mildly affected children. The origins of psychological problems in this group are complex but include ‘disease’ and ‘psychosocial’ factors related to having a brain-based disability in the family, as well as other factors that influence adjustment in all children. There are no intervention studies in children with CP aimed at preventing psychological problems or promoting mental wellbeing. However, evidence from other work suggests it is possible to work with the child and family to develop skills, manage symptoms, and build confidence and resilience. Acting as early as possible has been found to be beneficial for bonding, child development and reducing parental anxiety.