The effectiveness of PROMPT therapy for children with cerebral palsy

The purpose of this study is to evaluate the effectiveness of a motor speech treatment approach (PROMPT) in the management of motor-speech impairment in children with cerebral palsy. Two main objectives were addressed: (1) to evaluate changes in speech intelligibility and, (2) evaluate changes in kinematic movements of the jaw and lips using three dimensional (3D) motion analysis.A single subject multiple-baseline-across-participants research design, with four phases: Baseline (A1), two intervention phases (B and C) and maintenance (A2), was implemented.Six participants, aged 3-to-11-years (3 boys, 3 girls) with moderate to severe speech impairment were recruited through The Centre for Cerebral Palsy, Western Australia (TCCP). Inclusion criteria were: diagnosis of cerebral palsy, age 3 – 14 years, stable head control (supported or independent), spontaneous use of at least 15 words, speech impairment ≥1.5 standard deviations, hearing loss no greater than 25dB, developmental quotient ≥70 (Leiter-Brief International Performance Scale R) and no previous exposure to PROMPT. Thirteen typically-developing peers were recruited to compare the trend of kinematic changes in jaw and lip movements to those of the children with cerebral palsy.Upon achievement of a stable baseline, participants completed two intervention phases both of 10 weeks duration. Therapist fidelity to the PROMPT approach was determined by a blinded, independent PROMPT Instructor.Perceptual outcome measures included the administration of weekly speech probes, containing trained and untrained vocabulary at the two targeted levels of intervention plus an additional level. These were analysed for both perceptual accuracy (PA) and the motor speech movement parameter. End of phase measures included: 1. Changes in phonetic accuracy as measured using a measure of percentage phonemes correct; 2. Speech intelligibility measures, using a standardised assessment tool; and 3. Changes to activity/participation using the Canadian Occupational Performance Measure (COPM).Kinematic data were collected at the end of each study phase using 3D motion analysis (Vicon Motus 9.1). This involved the collection of jaw and lip measurements of distance, duration and velocity, during the production of 11 untrained stimulus words. The words contained vowels that spanned the articulatory space and represented motor-speech movement patterns at the level of mandibular and labial-facial control, as classified according to the PROMPT motor speech hierarchy.Analysis of the speech probe data showed all participants recorded a statistically significant improvement. Between phases A1-B and B-C 6/6 and 4/6 participants respectively, recorded a statistically significant increase in performance level on the motor speech movement patterns (MSMPs) targeted during the training of that intervention priority (IP). The data further show that five participants (one participant was lost to follow-up) achieved a statistically significant increase at 12- weeks post-intervention as compared to baseline (phase A1).Four participants achieved a statistically significant increase in performance level in the PA of the speech probes of both IP1 and IP2 between phases A1-B. Whilst only one participant recorded a statistically significant increase in PA between phases BC, five participants achieved a statistically significant increase in IP2 between phases A1-C. The data further show all participants achieved a statistically significant increase in PA on both intervention priorities at 12-weeks post-intervention. All participants recorded data that indicated improved perceptual accuracy across the study phases. This was indicated by a statistically significant increase in the percentage phonemes correct scores F(3,18) = 5.55, p<.05.All participants achieved improved speech intelligibility. Five participants recorded an increase in speech intelligibility greater than 14% at the end of the first intervention (phase B). Continued improvement was observed for 5 participants at the end of the second intervention (phase C)

Strongyloides seroprevalence before and after an ivermectin mass drug administration in a remote Australian Aboriginal community

Background: Strongyloides seroprevalence is hyper-endemic in many Australian Aboriginal and Torres Strait Islander communities, ranging from 35–60%. We report the impact on Strongyloides seroprevalence after two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community. Methods: Utilizing a before and after study design, we measured Strongyloides seroprevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined changes in serostatus. Serodiagnosis was undertaken by ELISA that used sonicated Strongyloides ratti antigen to detect anti-Strongyloides IgG. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 10–42 days if Strongyloides and/or scabies was diagnosed; others followed a standard alternative algorithm. A questionnaire on clinical symptoms was administered to identify adverse events from treatment and self-reported symptoms associated with serostatus. Findings: We surveyed 1013 participants at the baseline population census and 1060 (n = 700 from baseline cohort and 360 new entrants) at month 12. Strongyloides seroprevalence fell from 21% (175/818) at baseline to 5% at month 6. For participants from the baseline cohort this reduction was sustained at month 12 (34/618, 6%), falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% (75/297) to 7% at month 18. Strongyloides positive seroconversions for the baseline cohort six months after each MDA were 2.5% (4/157) at month 6 and 1% at month 18, whilst failure to serorevert remained unchanged at 18%. At 12 months, eosinophilia was identified in 59% of baseline seropositive participants and 89% of seropositive new entrants, compared with 47%baseline seronegative participants and 51% seronegative new entrants. Seropositivity was not correlated with haemoglobin or any self-reported clinical symptoms. Clinical symptoms ascertained on the day of treatment and 24–72 hrs after, did not identify any adverse events. Significance: Two community ivermectin MDAs delivered 12 months apart by trained Aboriginal researchers in collaboration with non-Indigenous researchers resulted in a sustained and significant reduction in Strongyloides seroprevalence over 18 months. Similar reductions were seen in the baseline cohort and new entrants.</p

Session 1: Public health nutrition Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers’ positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers’ attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy International Clinical Practice Guideline Based on Systematic Reviews:International Clinical Practice Guideline Based on Systematic Reviews

IMPORTANCE: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline

Implementation fidelity of a smartphone application for population-based general movement assessment: The Early Moves study

Objective: To describe the infant and maternal characteristics of the Early Moves cohort and to assess representativeness to the general population, and to evaluate the implementation fidelity of an application-based collection of General Movement Assessment (GMA) videos at writhing and fidgety age. Study design: Prospective observational study. Mothers who had recently delivered or were enrolled to deliver at maternity hospitals in Perth, Western Australia, were recruited from November 2019 to December 2023. Sociodemographic and infant clinical characteristics were extracted from hospital records. Parents were invited to record GMA videos using the Baby Moves smartphone application, which were assessed for scorability by certified GM assessors. Results: A total of 3002 infants (mean gestation, 38.9 ± 1.7 weeks; 46.6% female) were recruited. Infants were representative of the local population with respect to key infant risk factors, although mothers were more likely to be Caucasian and reside in higher socioeconomic suburbs compared with the broader Perth metropolitan birth population. Overall adherence was 76%, with 2272 families returning at least 1 scorable GMA video, with the majority (\u3e69%) requiring personalized reminders to upload. Risk factors for nonengagement were infant prematurity, special care nursery stay, low maternal age, low socioeconomic status, minority ethnicity, and single caregiver mothers. Conclusions: Inclusive recruitment strategies and broad inclusion criteria supported participation from diverse sociodemographic groups and infants representative of the local population on key medical risk factors. Parent-recorded GMA can be implemented in a large population-based cohort, though application-based notifications alone may be insufficient to facilitate engagement. Population-based applications should ensure targeted implementation strategies to support priority families

An evaluation of the effectiveness of PROMPT therapy in improving speech production accuracy in six children with cerebral palsy

This study evaluates perceptual changes in speech production accuracy in six children (3 – 11 years) with moderate-to-severe speech impairment associated with cerebral palsy before, during, and after participation in a motor-speech intervention program (Prompts for Restructuring Oral Muscular Phonetic Targets). An A1BCA2 single subject research design was implemented. Subsequent to the baseline phase (phase A1), phase B targeted each participant’s first intervention priority on the PROMPT motor-speech hierarchy. Phase C then targeted one level higher. Weekly speech probes were administered, containing trained and untrained words at the two levels of intervention, plus an additional level that served as a control goal. The speech probes were analysed for motor-speech-movement-parameters and perceptual accuracy. Analysis of the speech probe data showed all participants recorded a statistically significant change. Between phases A1 – B and B – C 6/6 and 4/6participants, respectively, recorded a statistically significant increase in performance level on the motor speech movement patterns targeted during the training of that intervention. The preliminary data presented in this study make a contribution to providing evidence that supports the use of a treatment approach aligned with dynamic systems theory to improve the motor-speech movement patterns and speech production accuracy in children with cerebral palsy

Can, Want and Try: Parents' Viewpoints Regarding the Participation of Their Child with an Acquired Brain Injury

BACKGROUND: Acquired brain injury (ABI) is a leading cause of permanent disability, currently affecting 20,000 Australian children. Community participation is essential for childhood development and enjoyment, yet children with ABI can often experience barriers to participation. The factors which act as barriers and facilitators to community participation for children with an ABI are not well understood. AIM: To identify the viewpoints of parents of children with an ABI, regarding the barriers and facilitators most pertinent to community participation for their child. METHODS: Using Q-method, 41 parents of children with moderate/severe ABI sorted 37 statements regarding barriers and facilitators to community participation. Factor analysis identified three viewpoints. RESULTS: This study identified three distinct viewpoints, with the perceived ability to participate decreasing with a stepwise trend from parents who felt their child and family "can" participate in viewpoint one, to "want" in viewpoint two and "try" in viewpoint three. CONCLUSIONS: Findings indicated good participation outcomes for most children and families, however some families who were motivated to participate experienced significant barriers. The most significant facilitators included child motivation, supportive relationships from immediate family and friends, and supportive community attitudes. The lack of supportive relationships and attitudes was perceived as a fundamental barrier to community participation. SIGNIFICANCE: This research begins to address the paucity of information regarding those factors that impact upon the participation of children with an ABI in Australia. Findings have implications for therapists, service providers and community organisations

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Utilisation of coaching practices in early interventions in children at risk of developmental disability/delay: a systematic review

To conduct a systematic review of early intervention programs (0-5 years) utilising coaching practice characteristics, to identify (i) implementation fidelity; (ii) parent training processes, and (iii) outcome measures of capacity building in parents. The coaching practice characteristics of (1) joint planning, (2) observation, (3) action/practice, (4) reflection and (5) feedback identified by Rush and Shelden were utilised.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. A comprehensive search of 6 electronic databases was undertaken in March 2016 and updated in February 2018.Of 2397 articles, 18 papers met full inclusion criteria. Of these, 5 were randomised controlled trials. Only one specifically evaluated the impact of parent coaching versus therapist only delivered interventions. Risk of bias and study quality using Downs and Black checklist for clinical trial quality yielded the following descriptive ratings: Seven studies: "Poor" (scores 1-13); Six studies: "Fair" (scores 15-17); and five "Good" (scores 20-24).Coaching in early intervention is well accepted. Nevertheless, this review identified a continued lack of operationalised definitions; inconsistency in the reporting of therapist training and adherence to active ingredients/coaching principles; and an absence of outcome measures focused on parent capacity. Implications for Rehabilitation Contemporary early intervention services recognise the importance of engaging parents as active participators in their child's development. This is evident by the increase in interventions that utilise parent coaching practices. The findings of this systematic review indicate the need for professionals to: •Describe and document fidelity of coaching practices in the delivery of intervention. •Objectively measure changes in parent capacity and self-efficacy as a result of the coaching based intervention. The reporting of parent capacity measures will allow us to truly examine the effectiveness of coaching practices in empowering families to support their child to realise their full potential