1,721,050 research outputs found
Surveillance of cerebral palsy in Norway; a national registry-based study
Full text linkWell-established cerebral palsy (CP) registries provide a solid framework to monitor, study and report on CP over time. This includes its causes, diagnosis, clinical manifestations and treatments/interventions. This thesis is a national registry-based study of individuals with CP born 1996 to 2010 and recorded in the Cerebral Palsy Registry of Norway (CPRN) and the Norwegian Patient Registry (NPR). Data from both registries were used to ensure that the studies were population-based. This was performed by linking the CPRN to the NPR, and validating all CP diagnosis codes recorded in the NPR, but not in the CPRN. Article I describes the results of the validation study, and the implications a complete and correct population can have on the calculation of prevalence estimates. The accurate prevalence of CP for individuals born in Norway during this study period is 2.4 per 1000 live births.
Article II continued with a more in-depth investigation of the trends in prevalence and severity of CP, using clinical data from the CPRN and supplemented with data from the NPR. We found a significant decline in the prevalence of CP from 2.6 per 1000 live births in 1999 to 1.9 in 2010. This was mostly attributed to a decrease in the more severe bilateral spastic CP subtype (characterized by muscular stiffness on both sides of the body). We also found a decrease in the proportion of individuals with CP and severe motor impairments, epilepsy, intellectual disability and reduced speech. This is the first time a reduction in the prevalence and severity of CP has been reported in Norway. The decline was most likely due to improvements in antenatal, obstetric and neonatal care that have been introduced nationwide throughout the past few decades. To support these findings, we also explored the status of perinatal health for all children born in Norway during this study period, using summary statistics from the Medical Birth Registry of Norway Statistics Bank. There, we found a decline in the prevalence of children born preterm, mothers with preeclampsia during pregnancy and with multiples, all of which are well-known risk factors for CP. In addition, there was also a decline in perinatal mortality.
Nonetheless, in article III we found that individuals who did receive a diagnosis of CP during this study period have a considerably higher burden of disease when compared with their peers in the general population without CP. Nearly all individuals with CP were recorded in the NPR with one or more disorders in addition to their CP condition (comorbidities), whether mild-to-severe or transient-to-chronic. When compared with the risks in the general population, individuals with CP had an excess risk for multiple medical, neurological and mental/behavioral disorders. As expected, many of the comorbidities were associated with the injury to the developing brain that caused CP (cocausal) or complications of the main CP condition. However, we also found that many comorbidities were also not intuitively related to CP.
This thesis demonstrates the importance of continual surveillance of the CP population in Norway. By monitoring fluctuations in the prevalence and clinical manifestations of CP over time, we can provide up-to-date information to healthcare professionals and support their work in preventing or minimizing the impact of CP
Assessment of hand function in children with bilateral cerebral palsy: Development and measurement properties of outcome measures and classifications
Full text linkMange barn med cerebral parese har vansker med å utføre daglige aktiviteter i hjem, skole eller barnehage på grunn av nedsatt håndfunksjon Til tross for det store omfanget av slike vansker, så er behandlingen som tilbys for å bedre håndfunksjonen i liten grad kunnskapsbasert. Dette gjelder spesielt behandling for å bedre håndfunksjonen hos barn med nedsatt funksjon i begge hender (bilateral CP). Hovedårsaken til dette er at man mangler gyldige og pålitelige måleredskaper som er følsomme nok til å måle endring. Funksjonelle klassifikasjoner og standardiserte tester med gode måleegenskaper er avgjørende for å kunne følge opp barnets naturlige utvikling og gi råd rundt forventet utvikling, samt for å kunne planlegge og evaluere aktuelle behandlingstilbud.
De viktigste målene med denne avhandlingen er derfor (1) å undersøke gyldighet (validitet) og pålitelighet (reliabilitet) til en mye brukt klassifisering av finmotorikk hos barn med CP, og (2) å bidra til bedre planlegging og evaluering av aktuelle tiltak ved å identifisere og utvikle standardiserte håndfunksjonstester med gode måleegenskaper for barn med bilateral CP.
Studie I og II undersøker validitet og reliabilitet av Bimanual Fine Motor Function (BFMF), som er en klassifisering av finmotorisk funksjon hos barn med CP. I studie I besto datasettet av BFMF og Manual Ability Classification System (MACS) klassifiseringer fra 539 barn med CP, mens i studie II ble 79 barn med CP inkludert. Studie III og IV undersøker måleegenskapene til standardiserte tester som evaluerer håndfunksjon hos barn med bilateral CP. Studie III er en systematisk litteraturgjennomgang som identifiserer tilgjengelige håndfunksjonstester og vurderer måleegenskapene til disse testene, mens studie IV beskriver utviklingen og valideringen av den nye testen, Both Hands Assessment (BoHA), der data fra 171 barn med bilateral CP ble benyttet.
Resultatene indikerer at BFMF er en valid og reliabel klassifisering av finmotorisk kapasitet hos barn med CP. Ved bruk av både BFMF og MACS, som klassifiserer faktisk bruk av hendene, kan man få en mer utfyllende beskrivelse av barnets håndfunksjon. Gjennom den systematiske litteraturgjennomgangen identifiserte vi et foreldre-rapportert spørreskjema og fire håndfunksjonstester. Spørreskjemaet måler hvor lett eller vanskelig det er for barnet å utføre ulike daglige aktiviteter som krever bruk av hendene, men gir ingen informasjon om det er en eller begge hender som brukes. Tre av håndfunksjonstestene evaluerer kapasitet til å bruke hver hånd for seg, mens den fjerde hovedsakelig evaluerer om barnet har aldersadekvat funksjon i dominant hånd. Best evidens for validitet og reliabilitet ble funnet for spørreskjemaet ABILHAND-kids og for testen Melbourne Assessment 2, men informasjon om følsomhet for endring mangler for begge disse instrumentene. Vi identifiserte ingen håndfunksjonstester som på en valid og reliabel måte måler hvordan barn med bilateral CP håndterer gjenstander ved bruk av begge hender. Derfor utviklet og validerte vi en ny test, Both Hands Assessment (BoHA), for å måle tohåndsfunksjon hos barn med bilateral CP (MACS nivå I-III). Resultatet av dette viser at BoHA er en valid test for barn med bilateral CP når den deles inn i to versjoner; en for barn med asymmetrisk (BoHA-A) og en for barn med mer symmetrisk bruk av hendene (BoHA-S). Ankring av disse to versjonene til samme måleskala gjør at resultatene som oppnås kan sammenlignes uavhengig av om barnet har en asymmetrisk eller mer symmetrisk bruk av hendene.
Denne avhandlingen viser at BFMF er en valid og reliabel klassifisering av finmotorisk funksjon hos barn med CP. Bruk av BFMF sammen med MACS vil kunne gi en mer nyansert beskrivelse av håndfunksjonen hos barn med CP, noe som er nyttig både i klinikk og forskning. For å kunne planlegge å måle effekt av ulike tiltak er det imidlertid behov for valide og reliable tester som er følsomme for endring. Melbourne Assessment 2 kan benyttes for å måle enhåndskapasitet hos barn med bilateral CP, mens ABILHAND-kids kan benyttes for å måle hvor lett eller vanskelig det er for barnet å utføre daglige aktiviteter som krever bruk av hendene. Det er imidlertid usikkert hvor godt disse måleinstrumentene fanger opp endring. Den nye testen BoHA gir en valid måling av spontan bruk av begge hender hos barn med bilateral CP og tilbyr dermed et nytt perspektiv som kan være nyttig ved planlegging og evaluering av tiltak. Fremtidige studier som undersøker reliabilitet og hvor godt BoHA fanger opp endring er imidlertid nødvendige
Assessment of Trunk Controlin Children and Adolescents with Cerebral Palsy: A neglected perspective?
Full text linkEt av hovedproblemene for mange barn, unge og voksne med cerebral parese (CP) er at de har redusert trunkus kontroll. Disse vanskene påvirker deres evne til å sitte og gå. Under gange er trunkus kontroll spesielt viktig, ettersom to tredjedeler av kroppsmassen er lokalisert i de øvre to tredjedeler av kroppshøyden, noe som gjør at kroppen har et høyt tyngdepunkt, og dermed blir ustabil. Likevel neglisjeres disse vanskene ofte når ressurskrevende behandlinger for å bedre gangfunksjonen vurderes. Slike behandlinger omfatter blant annet intramuskulære injeksjoner med botulinum toxin (BoNT-A), pumpebehandling med baklofen, ortopediskkirurgiske inngrep, og/ eller ortoser.
Dette kan delvis skyldes at det er få etablerte metoder for å undersøke trunkus kontroll i daglig klinisk arbeid, og at det er få studier som har undersøkt trunkus kontroll under gange i CP populasjonen. Hovedmålet med denne avhandlingen har derfor vært å bidra til bedre undersøkelse og forståelse av trunkus kontroll hos barn og ungdom med CP, både i sittende og under gange. Mer spesifikt var målet å identifisere og evaluere kliniske verktøy som undersøker trunkus kontroll samt å evaluere påliteligheten (intra- og inter observatør reliabilitet) og gyldigheten (validitet) av et slikt verktøy; Trunk Impairment Scale (TIS). Videre var det et mål å undersøke trunkus kontroll under gange samt å undersøke sammenhengen mellom trunkus kontroll i sittende og under gange.
I den første studien, en systematisk litteratur oversikt, identifiserte vi 22 kliniske verktøy som undersøker trunkus kontroll hos barn, ungdom og voksne med CP. Vi fant begrenset dokumentasjon av måleegenskapene til disse verktøyene, og informasjonen om egenskapen til å måle endring (responsiveness) var spesielt begrenset. Mangelen på verktøy som kan måle endring er en begrensning for gjennomføring av behandlingsstudier. I den andre studien fant vi at TIS, en av testene inkludert i den systematiske litteratur oversikten, viste høy inter- og intra observatør reliabilitet samt god validitet hos barn og ungdom med CP. I studie tre fant vi at barn og ungdom med CP hadde signifikante vansker med trunkus kontroll under gange, undersøkt med et 3-dimensjonalt askelerometer festet på nedre del av trunkus. Vanskene med trunkus kontroll ble reflektert gjennom økte trunkus akselerasjoner og mindre regularitet mellom steg, og de tenderte til å øke med økende alvorlighetsgrad av CP samt med økende gang hastighet. Til slutt, i studie fire, fant vi en moderat sammenheng mellom trunkus kontroll i sittende, undersøkt med en «del-test» av Trunk Control Measurement Scale og TIS, og trunkus kontroll under gange, undersøkt med et askelerometer festet på nedre del av trunkus.
Av relevans for klinisk praksis er at funnene i denne studien tyder på at de mindre tidkrevende «del-skalaene» kan benyttes for å innhente informasjon om trunkus kontroll under gange.
Det er et stort antall undersøkelsesverktøy beregnet på å undersøke trukus kontroll i ulike situasjoner tilgjengelig. Denne avhandlingen understreker at det er begrenset dokumentasjon av hvor godt disse verktøyene faktisk måler trunkus kontroll, og spesielt hvor gode de er til å måle effekt av behandling («responsiveness»). Våre resultater bekrefter at barn og ungdom med CP har vansker med trunkus kontroll både i sittende og under gange, og avhandlingen gir ny kunnskap om sammenhengen mellom disse to ulike oppgavene. Denne informasjonen bør føre til at fokuset i forbindelse med planlegging av intervensjoner som har til hensikt å bedre gangfunksjonen, utvides til også å omhandle en vurdering av pasientens trunkus kontroll.Poor trunk control is a primary impairment in children, adolescents, and adults with cerebral palsy (CP) and influences their activities in daily life such as sitting and walking. In the latter case, trunk control is especially important since two-thirds of the body mass (head, arms, and trunk) is located in the upper two-thirds of the body height, thus making the body unstable. Nonetheless, in the decision process leading to “gait interventions,” such as orthopedic surgery, botulinum toxin injections, intrathecal baclofen, and/or the application of orthoses, the focus is mainly on the lower extremities.
This may partly be due to few established methods for assessment of trunk control in daily clinical work, and that few studies have examined trunk control during gait in children and adolescents with CP. The main aim of this thesis is therefore to contribute to better assessment and understanding of trunk control in children and adolescents with CP, both in the sitting position and during gait. The specific aims during the research were to identify and evaluate clinical tools to assess trunk control and to evaluate the intra- and inter-observer reliability and construct validity of one such tool: the Trunk Impairment Scale (TIS). Further aims were to investigate trunk control during gait, and finally to investigate the relationship between trunk control during sitting and during gait.
In the first study, a systematic literature review, 22 clinical tools for assessment of trunk control in children, adolescents and adults with CP were identified. However, there was moderate or limited evidence for the measurement properties of the tools, and scarce information on the measurement property responsiveness. The latter is a limitation for intervention research which is dependent of the ability to evaluate change. In the second study, it was found that the TIS, one of the tools included in the review, showed high intraand inter- observer reliability, and the construct validity of the test involving children and adolescents with CP was considered as good. In the third study, children and adolescents with CP were found to have significant difficulties with trunk control during gait, which was assessed with a trunk-worn accelerometer. The difficulties were reflected in higher trunk acceleration and less regularity between strides than in children with typical development. These problems seemed to rise with increasing gross motor impairment and increasing speed. Finally, in the fourth study, a moderate relationship was found between trunk control during sitting assessed with a subscale score of the Trunk Control Measurement Scale and the TIS and trunk control during gait assessed with a trunk-worn accelerometer. With regard to relevance for clinical practice, the findings of the latter study suggest that the some of the less time-consuming subscales may be used to gain information on trunk control during gait.
A large number of assessment tools of trunk control are available. This thesis reveals that there is limited evidence for the measurement properties of the tools, especially for responsiveness. The results confirm that children and adolescents with CP have impaired trunk control both during sitting and gait, and provide new knowledge of the relationship between the two tasks. This information may expand the focus on the lower limbs in gait assessment in children and adolescents with CP to include assessment of the trunk.PhD i klinisk medisinPhD in Clinical Medicin
Test retest reliability of computer-based video analysis for the assessment of postural control in individuals with cerebral palsy
No full textBACKGROUND: Deficits in the control of posture is an important aspect of CP, as defined by SCPE and children with CP often exhibit activity limitations that are associated with postural control problems. However, there is a lack of adequate tools for assessing postural control in individuals with CP, and there is limited documentation of the measurement properties of the existing tools.
AIM: The first aim of this study was to explore if variables obtained using a computer-based video analysis software could be used to assess postural control. The second aim of this student thesis was to explore the test-retest reliability properties of these variables in individuals with CP and TD individuals 8-29 years of age.
METHOD: Thirteen individuals with CP and 24 typically developing (TD) individuals, 8-29 years, were asked to stand still while three videos recorded their movements from the side. The movements in the video recordings were quantified, using a computer-based video analysis.
RESULTS: In the explorative part of this study we found that the variables calculated by the computer-based video analysis that best correlated with the clinical assessment of postural control in the individuals with CP was the mean value of the centroid of motion (Cxmean) and its standard deviation (CxSD) in the horizontal axis. The centroid of motion is the spatial centre of all movements in the picture. In further analyses, the Cxmean showed the best correlations with GMFM-66, a clinical assessment tool for postural control, while the correlations were low for CxSD.
In the second part, I found that when we included all participants in the analyses, the ICC values of Cxmean ranged between 0.89 and 0.93, and of CxSD ranged between 0.92 and 0.93. The ICC values of Cxmean and CxSD were higher with more narrow confidence intervals when two video recordings, each of 30 seconds duration, were included, than when a third video recording of two minutes was included in the calculations. The ICC values of Cxmean and CxSD were nearly identical when applying ICC(1,1) and ICC(3,1).
The standard error of measurement (SEM) for Cxmean ranged from 2.2 (4 %) to 3.1 (6 %), expressing a small degree of measurement error. The smallest detectable difference (SDD) for Cxmean ranged from 6.0 (10 %) to 8.5 (15 %). However, the SEM values for CxSD ranged from 0.3 (14 %) to 0.7 (27 %), and the SDD values from 0.7 (40 %) to 2.0 (76 %). The Bland-Altman plots for Cxmean verifies graphically the consistency of the 3 video recordings. The Bland-Altman plots for CxSD verifies graphically the consistency of the measures in TD group, while it illustrates a spread in the values in the individuals with CP. The difference between the CxSD values from the two recordings were larger in the individuals with CP than in those with TD.
CONCLUSION: We found that the variable Cxmean from the computer-based video analysis software describes certain aspects of postural control in individuals with CP, 8-29 years. The test-retest reliability of this variable is good. However, more studies are required to further evaluate this method and to explore if other variables of the computer-based video analysis may better describe other aspects of postural control
Test retest reliability of computer-based video analysis for the assessment of postural control in individuals with cerebral palsy
Full text linkBACKGROUND: Deficits in the control of posture is an important aspect of CP, as defined by SCPE and children with CP often exhibit activity limitations that are associated with postural control problems. However, there is a lack of adequate tools for assessing postural control in individuals with CP, and there is limited documentation of the measurement properties of the existing tools.
AIM: The first aim of this study was to explore if variables obtained using a computer-based video analysis software could be used to assess postural control. The second aim of this student thesis was to explore the test-retest reliability properties of these variables in individuals with CP and TD individuals 8-29 years of age.
METHOD: Thirteen individuals with CP and 24 typically developing (TD) individuals, 8-29 years, were asked to stand still while three videos recorded their movements from the side. The movements in the video recordings were quantified, using a computer-based video analysis.
RESULTS: In the explorative part of this study we found that the variables calculated by the computer-based video analysis that best correlated with the clinical assessment of postural control in the individuals with CP was the mean value of the centroid of motion (Cxmean) and its standard deviation (CxSD) in the horizontal axis. The centroid of motion is the spatial centre of all movements in the picture. In further analyses, the Cxmean showed the best correlations with GMFM-66, a clinical assessment tool for postural control, while the correlations were low for CxSD.
In the second part, I found that when we included all participants in the analyses, the ICC values of Cxmean ranged between 0.89 and 0.93, and of CxSD ranged between 0.92 and 0.93. The ICC values of Cxmean and CxSD were higher with more narrow confidence intervals when two video recordings, each of 30 seconds duration, were included, than when a third video recording of two minutes was included in the calculations. The ICC values of Cxmean and CxSD were nearly identical when applying ICC(1,1) and ICC(3,1).
The standard error of measurement (SEM) for Cxmean ranged from 2.2 (4 %) to 3.1 (6 %), expressing a small degree of measurement error. The smallest detectable difference (SDD) for Cxmean ranged from 6.0 (10 %) to 8.5 (15 %). However, the SEM values for CxSD ranged from 0.3 (14 %) to 0.7 (27 %), and the SDD values from 0.7 (40 %) to 2.0 (76 %). The Bland-Altman plots for Cxmean verifies graphically the consistency of the 3 video recordings. The Bland-Altman plots for CxSD verifies graphically the consistency of the measures in TD group, while it illustrates a spread in the values in the individuals with CP. The difference between the CxSD values from the two recordings were larger in the individuals with CP than in those with TD.
CONCLUSION: We found that the variable Cxmean from the computer-based video analysis software describes certain aspects of postural control in individuals with CP, 8-29 years. The test-retest reliability of this variable is good. However, more studies are required to further evaluate this method and to explore if other variables of the computer-based video analysis may better describe other aspects of postural control
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Power Quandles
Full text linkVi introduserer kategorien bestående av potensquandler og studerer den glemsomme funktoren Pq fra grupper til potensquandler sammen med dens venstreadjungerte, Gr. Vi formoder at hvis to endelige grupper har isomorfe potensquandler, da er de isomorfe som grupper, og vi beviser noen resultater i denne retningen. Noen av disse resultatene er formelt verifisert i Lean theorem prover.We introduce the category of power quandles, and study the forgetful functor Pq from groups to power quandles together with its left adjoint Gr. We conjecture that if two finite groups have isomorphic power quandles, then they are isomorphic as groups, and prove several partial results in this direction. Several of these new results are formally verified in the Lean theorem prover
Power Quandles
No full textVi introduserer kategorien bestående av potensquandler og studerer den glemsomme funktoren Pq fra grupper til potensquandler sammen med dens venstreadjungerte, Gr. Vi formoder at hvis to endelige grupper har isomorfe potensquandler, da er de isomorfe som grupper, og vi beviser noen resultater i denne retningen. Noen av disse resultatene er formelt verifisert i Lean theorem prover
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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