Figure - uploaded by Sibel Mandiroglu
Content may be subject to copyright.
Source publication
Design and methods:
A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hosp...
Context in source publication
Context 1
... logistic regression analysis was applied to reveal risk factors between the fallers and non-fallers among children with the ability to stand. After adjustment for possible risk factors, logistic regression analysis revealed that having behavioral problems according to the statement of the mother (15.433 fold), having a history of frequent falls (5.218 fold) and each additional point scored on the Berg Balance Scale (1.032 fold), increased the risk of inpatient falls among these children with CP who are able to stand (Table 6). ...Citations
... Falls are the most common type of adverse events reported for hospitalized children (Alemdaroglu et al., 2017;Fujita et al., 2013;Lee et al., 2013), which can cause serious harm to paediatric patients (AlSowailmi et al., 2018;Feuerlicht et al., 2020;Kim & Lee, 2021), and increase the length of stay (Almis et al., 2017). As a result, falls of inpatient children are an important issue as part of initiatives to prevent inpatient safety accidents . ...
Aim:
The aim of the study was to develop an evidence-based care bundle protocol for preventing falls in hospitalized children.
Design:
Delphi method.
Methods:
Based on the four basic concepts of nursing, the theoretical dimension and item pool of the care bundle first draft were constructed by searching evidence and referring to the care bundle for preventing inpatient fall issues by the China Nursing Quality Promotion Alliance. The Delphi method and trial tests were used to select and adjust items of the care bundle to form the care bundle protocol for preventing falls in hospitalized children.
Results:
The first draft care bundle for preventing falls in hospitalized children included 4 dimensions and 21 items. In the 2-round Delphi study, one item was removed, and three items were adjusted. One item was adjusted by trial test. Finally, the care bundle protocol for preventing falls in hospitalized children consisted of 4 dimensions and 20 items.
... With a prevalence of 1.77 per 1000 live births in Europe, CP is the most common cause of significant motor impairment in children [2]. Stability is reduced in children with CP because of motor and cognitive impairments, which can lead to falls [3]. Most falls happen while walking, one of the most frequent motor activities [4]. ...
... Most falls happen while walking, one of the most frequent motor activities [4]. If a child is able to ambulate independently, she/he will consequently increase her/his risk of falling [3]. Children with disabilities are more exposed to concussions when falling than non-disabled children, who generally suffer from less severe damage, such as upper limb injuries [5]. ...
Aim
The aim of this cross-sectional study was to measure the effect of dual tasks on gait stability in ambulant children with cerebral palsy (CP) compared to typically developing (TD) children.
Methods
The children of the CP (n = 20) and TD groups (n = 20) walked first without a dual task, then while counting forward and finally while alternatively naming fruits and animals (DT f/a ). They then completed the same cognitive exercises while sitting comfortably. We calculated the distance between the foot placement estimator (FPE) and the real foot placement in the anterior direction (D FPE AP) and in the mediolateral direction (D FPE ML) as a measure of gait stability, in a gait laboratory using an optoelectronic system. Cognitive scores were computed. Comparisons within and between groups were analysed with linear mixed models.
Results
The dual task had a significant effect on the CP group in D FPE AP and D FPE ML. The CP group was more affected than the TD group during dual task in the D FPE ML. Children in both groups showed significant changes in gait stability during dual tasks.
Interpretation
The impact of dual task on gait stability is possibly due to the sharing of attention between gait and the cognitive task. All children favoured a ‘posture second’ strategy during the dual task of alternatively naming animals and fruits. Children with CP increased their mediolateral stability during dual task.
... Children with CP are prone to fall. The fall rate of inpatient children with CP was reported to be 27% in a prospective study [4]. Approximately 35% of children reported daily falling, and 30% of them fell monthly or weekly according to a retrospective study [5]. ...
Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.
... Abnormal postural stability, defined as inability of postural control to maintain upright stance in response to a sudden perturbation generated from external or internal (i.e. from neuromuscular system) sources (van Emmerik et al., 2016), and irregular pattern of walking causes falls (El-Shamy and Abd El Kafy, 2014;Hsue et al., 2009) which are a formidable problem of pediatric population (Chadwick and Salerno, 1993;Pitone and Attia, 2006). Children with CP demonstrate several gait characteristics that increase fall risk among children (Alemdaroğlu et al., 2017). Gait impairments are considered as one of the most important consequences of CP (Armand et al., 2016;Aycardi et al., 2019). ...
Background:
Studies have demonstrated that ambulatory children and adolescents with cerebral palsy demonstrate atypical gait patterns. Out of numerous gait variables, identification of the most deteriorated gait parameters is important for targeted and effective gait rehabilitation. Therefore, this study aimed to identify the gait parameters with the most discriminating nature to distinguish cerebral palsy gait from normal gait.
Methods:
Multiple databases were searched to include studies on ambulatory children and adolescents with cerebral palsy that included gait (spatio-temporal, kinematic, and kinetic) and dynamic stability variables.
Findings:
Of 68 studies that met the inclusion criteria, 35 studies were included in the meta analysis. Effect size was used to assess the discriminative strength of each variable. A large effect (≥ 0.8) of cerebral palsy on double limb support time (Standardized Mean Difference = 0.98), step length (Standardized Mean Difference = 1.65), step width (Standardized Mean Difference = 1.21), stride length (Standardized Mean Difference = 1.75), and velocity (Standardized Mean Difference = 1.42) was observed at preferred-walking speed. At fast-walking speed, some gait variables (i.e. velocity and stride length) exhibited larger effect size compared to preferred-walking speed. For some kinematic variables (e.g. range of motion of pelvis), the effect size varied across the body planes.
Interpretation:
Our systematic review detects the most discriminative features of cerebral palsy gait. Non-uniform effects on joint kinematics across the anatomical planes support the importance of 3D gait analysis. Differential effects at fast versus preferred speeds emphasize the importance of measuring gait at a range of speeds.
When a patient falls within a hospital setting, there is a significant increase in the risk of severe injury or health complications. Recognizing factors associated with such falls is crucial to mitigate their impact on patient safety. This review seeks to analyze the factors contributing to patient falls in hospitals. The main goal is to enhance our understanding of the reasons behind these falls, enabling hospitals to devise more effective prevention strategies. This study reviewed literature published from 2013 to 2022, using the Arksey and O’Malley methodology for a scoping review. The research literature was searched from seven databases, namely, PubMed, ScienceDirect, Wiley Library, Garuda, Global Index Medicus, Emerald Insight, and Google Scholar. The inclusion criteria comprised both qualitative and quantitative primary and secondary data studies centered on hospitalized patients. Out of the 893 studies analyzed, 23 met the criteria and were included in this review. Although there is not an abundance of relevant literature, this review identified several factors associated with falls in hospitals. These encompass environmental, patient, staff, and medical factors. This study offers valuable insights for hospitals and medical personnel aiming to enhance fall prevention practices. Effective prevention efforts should prioritize early identification of patient risk factors, enhancement of the care environment, thorough training for care staff, and vigilant supervision of high-risk patients. By comprehending the factors that contribute to patient falls, hospitals can bolster patient safety and mitigate the adverse effects of falls within the health-care setting.
Introduction
Treadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children’s functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System.
Methods and analysis
This study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic – Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30 min for each session. Assessments will be performed on three occasions: 1 week before the intervention, 1 week following the intervention and 1 month after the end of the intervention. The evaluations will involve the 6 min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used.
Ethics and dissemination
The study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences.
Trial registration number
NCT05131724 .
Aim
The aim of this prospective cross-sectional study with matched controls was to measure the effect of dual tasks on gait stability in ambulant children with cerebral palsy (CP) compared to typically developing (TD) children.
Methods
The children of the CP (n= 20) and TD groups (n=20) walked first without a dual task, then while counting and finally while alternatively naming fruits and animals (DT f/a ). They then completed the same cognitive exercises while sitting comfortably. We calculated the distance between the foot placement estimator (FPE) and the real foot placement in the anterior direction (D FPE AP) and in the mediolateral direction (D FPE ML) as a measure of gait stability, in a gait laboratory using an optoelectronic system. Cognitive scores were computed. Comparisons within and between groups were analysed with linear mixed models.
Results
The dual task had a significant effect on the CP group in D FPE AP and D FPE ML. The CP group was more affected than the TD group during dual task in the D FPE ML. Children in both groups showed significant changes in gait stability during dual tasks.
Interpretation
The impact of dual task on gait stability is possibly due to the sharing of attention between gait and the cognitive task. All children favoured a ‘posture second’ strategy during the dual task of alternatively naming animals and fruits. Children with CP increased their mediolateral stability during dual task.
Purpose
This pilot project evaluated the feasibility of conducting a study describing parental characteristics associated with pediatric hospital falls.
Design and methods
This observational case-control study enrolled parent-child dyads of children who fell in the hospital and age-matched controls. Parents completed demographic, anxiety, depression, fatigue, sleep disturbance and stress questionnaires.
Results
Four of 14 (28.6%) eligible faller dyads were recruited. Stress scores were correlated with anxiety and depression scores. Power calculations indicated a need for 392 fallers for a future study to identify associations of parent characteristics and pediatric hospital falls.
Conclusions
Parents should be informed the ultimate goal of the research is to understand additional ways to prevent pediatric hospital falls. To decrease parental distraction during recruitment, researchers should engage volunteers or child life specialists to entertain younger children. Future studies should consider inclusion of non-English speaking subjects and children discharged within the post-fall eligibility time frame. To decrease multicollinearity concerns, the parent stress tool should be omitted. Due to the large number of fallers needed for an adequately powered sample, a multi-site study will be needed.
Practice implications
A parent is often present when their child falls in the hospital. Fall risk assessment focuses on patient characteristics, neglecting parental psychophysical characteristics which may be associated with risk of falling in the hospital. Associations of parent psychophysical characteristics and pediatric hospital falls needs to be studied further. This pilot study supports the feasibility of and provides recommendations for conducting a study to describe parent characteristics associated with pediatric hospital falls.
Aim
To compare the rate of falls between adults with and without cerebral palsy (CP).
Method
We used primary care data on 1705 adults with CP and 5115 adults without CP matched for age, sex, and general practice attended. We compared odds of experiencing a fall between adults with and without CP using conditional logistic regression. We compared the rate of falls using a negative binomial model.
Results
Participants were 3628 males (53%) and 3192 females (47%) (median age 29y, interquartile range 20–42y) at the start of follow‐up. Follow‐up was 14 617 person‐years for adults with CP and 56 816 person‐years for adults without CP. Of adults with CP, 15.3% experienced at least one fall compared to 5.7% of adults without CP. Adults with CP had 3.64 times (95% confidence interval [CI] 2.98–4.45) the odds of experiencing a fall compared to adults without CP. The rate of falls was 30.5 per 1000 person‐years and 6.7 per 1000 person‐years for adults with and without CP respectively (rate ratio 5.83, 95% CI 4.84–7.02)
Interpretation
Adults with CP are more likely to fall, and fall more often, than adults without CP. The causes and consequences of falls in adults with CP need examination.
What this paper adds
Twenty adults with CP and 5.3 adults without CP experienced at least one fall per 1000 person‐years.
Adults with CP experienced 30.5 falls per 1000 person‐years compared to 6.7 falls per 1000 person‐years among adults without CP.
Adults with CP had 3.64 times the odds of experiencing a fall compared to adults without CP.
Adults with CP experienced 5.83 times more falls than adults without CP.
Purpose:
While there has been extensive published research into adult inpatient falls, less is known about pediatric falls in Australia. Falls pose a safety risk to pediatric patients potentially causing harm, increased length of stay, and death. Parents play a central role in reducing falls-related incidents given that, as parents, they provide care and/or oversee care delivered to their child at the bedside. Developing a better understanding of what parents and carers know about falls and associated risks, particularly those hospital-naïve, is central to developing family centered strategies and targeted education to meet the needs of parents. Our study aimed to explore Australian parents' knowledge and awareness of pediatric inpatient falls.
Design:
Qualitative methods utilizing descriptive thematic analysis.
Methods:
Parents of children and/or young people hospitalized during the last 6 months were eligible to participate. Potential participants attending the outpatient clinics of two tertiary pediatric outpatient clinics hospitals in Sydney, Australia were invited to participate in the study. Willing participants consented to complete a face to face in-depth interview. Open-ended questions sought to explore participants' knowledge, knowledge acquisition, and awareness of inpatient falls. Interviews were digitally recorded and transcribed verbatim. Data familiarization and open coding were completed by researchers independently. Researchers explored and discussed emerging categories until patterns emerged and a consensus of dominant themes were agreed upon.
Results:
Interviews were conducted with mothers (n = 17), fathers ( n = 4), or both parents together (n = 2) of a child or a young person who had been recently hospitalized. Four dominant themes emerged from the data namely: Supervision: falls won't happen, unexpected, parent priorities, and ways of learning about inpatient falls and risks. Despite parents' awareness of falls risk, parents were unaware that falls occur within a hospital setting and did not prioritize "falls prevention" during admission.
Practice implications:
Findings have implications for nursing practice, particularly in the delivery, content, and timing of falls prevention education.
