'Multidisciplinary appraisal of the British Institute for Brain Injured Children, Somerset, UK'.
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Brain Injuries↗
Biomedical subjects
E Bower
Publications and source records attributed to E Bower.
A randomised controlled trial of different intensities of physiotherapy and different goal-setting procedures in 44 children with cerebral palsy.
Forty-four children aged 3 to 11 years with quadriplegic cerebral palsy were prospectively stratified and randomised into four treatment groups. The acquisition of motor skills was assessed in a 2 x 2 factorial design using the Gross Motor Function Measure. The two factors were conventional amounts of physiotherapy vs intensive amounts of physiotherapy, and the use of broad, generalised aims vs the use of specific measurable goals directed at motor skill acquisition. 82% of the children improved. Over the two-week period, intensive physiotherapy produced a slightly greater effect than conventional physiotherapy but the factor more strongly associated with increased motor skill acquisition was the use of specific measurable goals.
Adolescent↗
Assessing motor-skill acquisition in four centres for the treatment of children with cerebral palsy.
An inventory of factors has been established that are important in defining the nature and circumstances of centres providing treatment for children with cerebral palsy. A method was developed for assessing the precision of the effects of aim- or goal-setting procedures, which were found to differ widely between centres. A knowledge of these factors and an understanding of the needs of individual parents and children is of potential value in the design of future trials employing randomisation and control of biasing factors, and in helping parents choose the centre most likely to meet their needs.
Cerebral Palsy↗
Physiotherapy for cerebral palsy: a historical review.
In view of the fact that brain damage cannot be reversed in cerebral palsy, it seems unlikely that there will be recovery other than maturation and compensatory movement. Therefore the two most important aims of treatment would appear to be to delay deformity and to promote the psychological well-being of the child within his or her own family unit. To facilitate these aims research needs to be undertaken by clinical scientists to assess the relative merits of the various approaches. Research methodologies used in psychology and the social sciences may well prove to be more useful for this purpose than those used in traditional medical research. To quote Harris (1989): 'Every discipline evolves its methods in response to the needs of the time and through the genius of its individual practitioners and we will learn how best to combine descriptive research with quantitative methods, with experiment and with techniques not yet invented'.
Cerebral Palsy↗
Myosin II distribution in neurons is consistent with a role in growth cone motility but not synaptic vesicle mobilization.
We have generated a polyclonal antibody against myosin II from a neuronally derived cell line in order to assess potential roles for myosin II in growth cone movement and synaptic transmission. The distribution of neuronal myosin II, in isolated cells as well as in tissues of the adult rat brain and spinal cord, was examined at the light microscopic and ultrastructural levels. In isolated neuroblastoma cells and dorsal root ganglion neurons, myosin II was found at the leading edge of growth cones, within neuritic processes and cell soma, and adjacent to the plasma membrane. The subcellular distribution of myosin II overlapped significantly with that of both actin and single-headed myosin I. These results implicate both myosin I and myosin II as molecular motors required for neurite elongation and growth cone motility. An exclusive postsynaptic distribution of myosin II in neurons of the mature central nervous system suggests that myosin II cannot play a role in the mobilization of synaptic vesicles, but could participate in synaptic plasticity.
Animals↗
Effect of increased exposure to physiotherapy on skill acquisition of children with cerebral palsy.
This pilot study reports the effects of increased exposure to standard physiotherapy on seven children with quadriplegic cerebral palsy and severe learning difficulties. The children's progress toward certain goals was accelerated during the period of intense physiotherapy, but progress toward other goals was less consistently affected. These skills were maintained, and in some cases improved upon, when therapy became less frequent, provided they were associated with daily functional activities understood by the children and not requiring increased assistance by the carer. The identification of specific, measurable goals can help establish the effectiveness of treatment for such children and may in itself have beneficial effects on compliance and outcome.
Activities of Daily Living↗
The effects of physical therapy on cerebral palsy.
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Cerebral Palsy↗
Faculty and professional staff development--security versus change.
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Education, Nursing, Associate↗
Evaluating therapy in cerebral palsy.
The optimal design for most clinical trials of treatment is the randomized controlled group trial. This methodology is not, however, uniformly applicable or appropriate. The evaluation of physiotherapy in the management of cerebral palsy in childhood is a good example of treatment for which modification of this trial design is needed. Some of the problems with eight studies in this field published between 1960 and 1993 are reviewed here and an alternative approach proposed. A representative series of single case studies with individual goal setting and a validated outcome measurement, using randomized treatment, would overcome many of the disadvantages of published studies at a greatly reduced cost. The results would enable more effective group trials to be mounted in due course to evaluate the probable impact of providing treatment to a defined population of subjects.
Bias↗