Design & Methods Background The high energy demands of the spasticity and dystonia frequently...
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Design & Methods Background •The high energy demands of the spasticity and dystonia frequently associated with CP may affect engagement in activities such as eating and standing 1 •A reduction in participation is often seen in children with Cerebral Palsy (CP) as compared to typically developing children 2 •ITB has been shown to decrease spasticity in individuals with CP. ITB is implanted into the abdominal wall system and controls spasticity by infusing baclofen directly into the spinal cord 3 Purpose of Study •To determine if children with CP experience an increase in participation if their resting energy expenditure (REE) decreases as a result of ITB treatment Hypotheses 1.REE will decrease as a result of ITB treatment 2.Participation will increase as a result of ITB treatment 3.A decrease in REE will be associated with increased participation RESULTS CONCLUSIONS INTRODUCTION Acknowledgements Thank you Dr. Ruth Benedict and Dr. Martha McCurdy for your guidance, patience, and expertise! This research was made possible by the CP International Research Foundation, Pedal with Pete Foundation, the UW-Madison Graduate School, The Wisconsin Alumni Research Foundation, and Virginia Horne Henry Fund for Women’s Physical Activity and Health. Implications for Practice • Despite a clear trend in several individuals the current study lacked sufficient power to show a change in REE or participation as a result of ITB treatment. • Of the 3 participants who had a decrease in REE, 2 showed an increase in participation. However, of the 4 participants reported to have improved participation, only 2 showed a decrease in REE. Thus, it cannot be concluded that a decrease in REE is associated with an increase in participation. • Study limitations include: small sample size, the possibility that the CAPE is not sensitive enough to detect changes among low functioning children, or measurement errors in using the VO2000 (e.g. not tolerating mask, inability to achieve resting state). •OTs should tell families that ITB may decrease energy demands and increase participation for some individuals but that a decrease in energy expenditure does not necessarily predict participation outcomes •OTs should offer suggestions to families for ways to increase involvement in activities and provide strategies for managing energy demands among children and young adults with CP in order to maximize participation in community life. Participants Design • Descriptive, case series Measures •Children’s Assessment of Participation and Enjoyment (CAPE): measures intensity on 7 pt scale • VO2000: Portable Indirect Calorimetry device for measuring REE. Captures volume of O2 and CO2 during respiration via a mask worn by the child Analysis •A Wilcoxon Signed Rank test was done to References Participation • Participation did not differ between pre and post intervention scores (z = -1.38, p = .17). CAPE positive ranks indicate participation decreased in 4 out of 6 participants • No difference was found for REE between pre and post intervention measures (z = -.94, p = .34). REE negative ranks indicate REE decreased in 3 out of 6 participants. Two of these participants decreased by more than 800 calories/day/Kg Resting Energy Expenditure (REE) Figure 1. Change in REE (Calories/Day/Kg) From Initial to 6-Month Measurement. Figure 2. Change in CAPE Sum Score From Initial to 6-Month Measurement. 1. Stallings, V. A., Zemel, B. S., Davies, J. C., Cronk, C. E., & Charney, E. B. (1996). Energy expenditure of children and adolescents with severe disabilities: A cerebral palsy model. The American Journal of Clinical Nutrition, 64(4), 627-634. 2. Hemingway, C., McGrogan, J., & Freeman, J. M. (2001). Energy requirements of spasticity. Developmental Medicine and Child Neurology, 43(4), 277-278. 3. Francisco, G. E., Saulino, M. F., Yablon, S. A., & Turner, M. (2009). Intrathecal baclofen therapy: An update. PM & R : The Journal of Injury, Function, and Rehabilitation,1(9), 852-858. doi: 10.1016/j.pmrj.2009.07.015; 10.1016/j.pmrj.2009.07.015 A decrease in REE was not associated with an increase in participation. Some participants showed a decrease in CAPE score and others increased their score after 6 months of ITB intervention.
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Transcript of Design & Methods Background The high energy demands of the spasticity and dystonia frequently...
Design & Methods
Background•The high energy demands of the spasticity and dystonia frequently associated with CP may affect engagement in activities such as eating and standing1
•A reduction in participation is often seen in children with Cerebral Palsy (CP) as compared to typically developing children2
•ITB has been shown to decrease
spasticity in individuals with CP.
ITB is implanted into the abdominal wall system and controls spasticity by infusing baclofen directly into the spinal cord3
Purpose of Study•To determine if children with CP experience an increase in participation if their resting energy expenditure (REE) decreases as a result of ITB treatment
Hypotheses1.REE will decrease as a result of ITB treatment
2.Participation will increase as a result of ITB treatment
3.A decrease in REE will be associated with increased participation
RESULTS CONCLUSIONSINTRODUCTION
Acknowledgements
Thank you Dr. Ruth Benedict and Dr. Martha McCurdy for your guidance, patience, and expertise! This research was made possible by the CP International Research Foundation, Pedal with Pete Foundation, the UW-Madison Graduate School, The Wisconsin Alumni Research Foundation, and Virginia Horne Henry Fund for Women’s Physical Activity and Health.
Implications for Practice
• Despite a clear trend in several individuals the current study lacked sufficient power to show a change in REE or participation as a result of ITB treatment.
• Of the 3 participants who had a decrease in REE, 2 showed an increase in participation. However, of the 4 participants reported to have improved participation, only 2 showed a decrease in REE. Thus, it cannot be concluded that a decrease in REE is associated with an increase in participation.
• Study limitations include: small sample size, the possibility that the CAPE is not sensitive enough to detect changes among low functioning children, or measurement errors in using the VO2000 (e.g. not tolerating mask, inability to achieve resting state).
•OTs should tell families that ITB may decrease energy demands and increase participation for some individuals but that a decrease in energy expenditure does not necessarily predict participation outcomes
•OTs should offer suggestions to families for ways to increase involvement in activities and provide strategies for managing energy demands among children and young adults with CP in order to maximize participation in community life.
Participants
Design• Descriptive, case series
Measures•Children’s Assessment of Participation and Enjoyment (CAPE): measures intensity on 7 pt scale
• VO2000: Portable Indirect Calorimetry device for measuring REE. Captures volume of O2 and CO2 during respiration via a mask worn by the child
Analysis•A Wilcoxon Signed Rank test was done to evaluate whether CAPE scores and REE measurements differed before and after ITB intervention
References
Participation • Participation did not differ between pre and post intervention
scores (z = -1.38, p = .17). CAPE positive ranks indicate participation decreased in 4 out of 6 participants
• No difference was found for REE between pre and post intervention measures (z = -.94, p = .34). REE negative ranks indicate REE decreased in 3 out of 6 participants. Two of these participants decreased by more than 800 calories/day/Kg
Resting Energy Expenditure (REE)
Figure 1. Change in REE (Calories/Day/Kg) From Initial to 6-Month Measurement.
Figure 2. Change in CAPE Sum Score From Initial to 6-Month Measurement. 1. Stallings, V. A., Zemel, B. S., Davies, J. C., Cronk, C. E., & Charney, E. B. (1996). Energy expenditure of children and adolescents with severe disabilities: A cerebral palsy model. The American Journal of Clinical Nutrition, 64(4), 627-634.
2. Hemingway, C., McGrogan, J., & Freeman, J. M. (2001). Energy requirements of spasticity. Developmental Medicine and Child Neurology, 43(4), 277-278.
3. Francisco, G. E., Saulino, M. F., Yablon, S. A., & Turner, M. (2009). Intrathecal baclofen therapy: An update. PM & R : The Journal of Injury, Function, and Rehabilitation,1(9), 852-858. doi: 10.1016/j.pmrj.2009.07.015; 10.1016/j.pmrj.2009.07.015
A decrease in REE was not associated with an increase in participation. Some participants showed a decrease in CAPE score and others increased their score after 6 months of ITB intervention.
