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Biomedical subjects

L T Miller

Publications and source records attributed to L T Miller.

At least 19 recordsLinked to original sources
PubMed2001

The search for subtypes of DCD: is cluster analysis the answer?

Studies using cluster analysis as a method to identify distinct subtypes of developmental coordination disorder (DCD) have been inconclusive leading some authors to conclude that the method of cluster analysis should be abandoned while others call for the validation of previously defined subtypes. The objective of the current study was to examine the use of cluster analysis as a method of searching for subtypes of DCD to gain a better understanding of how different samples and different measures influence the interpretation of results. The paper provides a detailed review of three commonly cited cluster analytical studies and then explores the possible reasons for the discrepant results by replicating the approach with a different clinical sample. The results highlight the impact of different measures on cluster structure and the importance of adoption of a common standard to facilitate interpretation across studies.

Child↗
PubMed2001

A pilot trial of a cognitive treatment for children with developmental coordination disorder.

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.

Child↗
PubMed2001

Clinical description of children with developmental coordination disorder.

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Adolescent↗
PubMed2001

Cognitive orientation to daily occupational performance (CO-OP): part III--the protocol in brief.

Parts I and II of this series introduced the Cognitive Orientation to daily Occupational Performance (CO-OP), a new approach to intervention that is based on the premise that cognition plays an important role in the acquisition of occupational skills and the development of occupational competency. Developed for use with children who have occupational performance deficits, CO-OP is an individualized, client-centred approach focused on strategy-based skill acquisition. This third paper in this series presents a brief description of the actual CO-OP protocol including its objectives, prerequisites and key features.

Child↗
PubMed2001

Cognitive strategies and motor performance in children with developmental coordination disorder.

Recently, researchers in occupational therapy have investigated the use of a cognitive or "top down" approach to improving the occupational performance of children with developmental coordination disorder. A cognitive approach is multifaceted in nature and one essential component of such an approach is the use of cognitive strategies. Although strategy use has a long history within the education and psychology literature, little discussion within the pediatric therapy literature has occurred. This paper reports the results of an in-depth videotape analysis of therapists using cognitive strategies during occupational therapy intervention. Eight domain specific strategies were identified and elucidated. This research will be beneficial to therapists who wish to incorporate a cognitive approach into their clinical practice.

Child↗
PubMed2001

Treatment of children with Developmental Coordination Disorder: what is the evidence?

Children with Developmental Coordination Disorder (DCD) experience significant difficulty performing everyday tasks and management of these children is a great source of debate. Because little is understood about the etiology of the disorder, treatment design has been driven by competing theories of motor development and motor skill acquisition. Traditional approaches to treatment have been based on neuromaturational, hierarchical theories and, consequently, therapies have focused on remeditating underlying deficits with the expectation of subsequent improvement in motor performance. Contemporary approaches, drawn from human movement science, propose that treatment methods be based on the assumption that skill acquisition emerges from the interaction of the child, the task and the environment. This paper provides a review of the treatment literature over the past 15 years, highlighting the fact that little evidence exists to suggest any one approach is better than another. Given current demands for evidence-based practice, and evolving concepts in skill acquisition, a movement toward interventions that are based on functional outcomes is recommended.

Child↗
PubMed2001

Cognitive orientation to daily occupational performance (CO-OP): part II--the evidence.

CO-OP is a child-centred, cognitive based intervention, focused on enabling children to achieve their functional goals. It has been developed over the last nine years through a series of systematic studies that have specified the treatment protocol and evaluated its effect. Initially CO-OP was explored in two series of single case experimental studies. Subsequently, an informal follow-up study and a detailed analysis of the video-taped sessions of the approach were completed. Based on information from these studies, the approach was refined, key features elucidated and the protocol was specified. Next, a pilot randomized clinical trial was completed. The trial was conducted to determine how best to approach a full scale randomized clinical trial on the effectiveness of CO-OP, relative to the current therapeutic approach. Finally, a retrospective chart audit was carried out to examine the cumulative evidence on the effectiveness of CO-OP in improving the performance of children with DCD. This paper presents a detailed summary of these five studies and discusses the implications of the findings.

Child↗
PubMed2001

Development and validation of a telephone questionnaire to characterize lymphedema in women treated for breast cancer.

BACKGROUND AND PURPOSE: Accurate and economical characterization of lymphedema is needed for population-based studies of incidence and risk. The purpose of this study was to develop and validate a telephone questionnaire for characterizing lymphedema. SUBJECTS: Forty-three women who were treated previously for breast cancer and who were recruited from physical therapy practices and a cancer support organization were studied. METHODS: Questionnaire assessment of the presence and degree of lymphedema was compared with physical therapists' diagnoses, based primarily on circumferential measurements. Twenty-five of the 43 subjects were measured independently by 2 physical therapists to assess interobserver agreement. RESULTS: Interobserver agreement on clinical assessments of the presence and degree of lymphedema was high (20/25, weighted kappa=.80); all of the disagreements were between judgments of whether there was no lymphedema or mild lymphedema. For the diagnosis of at least moderate lymphedema (differential in the circumferences of the upper extremities greater than 2 cm), sensitivity of the questionnaire varied from 0.86 to 0.92 and specificity was 0.90. However, sensitivity (varying from 0.93 to 0.96) was higher than specificity (varying from 0.69 to 0.75) for the diagnosis of any lymphedema. DISCUSSION AND CONCLUSION: A few straightforward questions exhibited excellent agreement with physical therapists' assessments for identifying at least moderate lymphedema.

Adult↗
PubMed1998

Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema.

BACKGROUND: Lymphedema is a relatively frequent complication following the management of breast carcinoma. Numerous therapeutic interventions have been offered to treat this potentially disabling and disfiguring condition. Consensus has not been attained among oncologists, surgeons, psychiatrists, and physical therapists concerning the appropriate treatment of lymphedema. METHODS: This review provides an overview of those treatment regimens that have been used in the past and, in some instances, have gone on to provide the foundation for the most widely prescribed interventions currently employed for the management of upper extremity lymphedema following breast carcinoma treatment. The use of intermittent pneumatic compression pumps as a part of an integrated multidisciplinary treatment approach incorporating garments, exercises, and massage also is discussed. RESULTS: A review of available literature suggests that a variety of traditional and commonly available techniques, when used appropriately in a multidisciplinary fashion, may lessen the cosmetic and physical impairments associated with acquired lymphedema. The role of surgery is unclear. Pharmacotherapies are a promising adjunct to manual and mechanical therapies. CONCLUSIONS: The appropriate use of readily available treatment approaches may lessen the severity of acquired lymphedema following breast carcinoma therapy. A comprehensive therapeutic approach should be employed in the management of lymphedema, including attention to the functional, cosmetic, and emotional sequelae of this potentially disabling condition. To that end, a recommendation for a comprehensive treatment regimen is provided.

Arm↗
PubMed1997

Developmental changes in speed of information processing in young children.

This study investigated developmental increases in processing speed in young children, relative to adults, with only nonverbal stimuli. R. Kail's (1991) model of the rate of change in processing speed from childhood to adulthood was evaluated. Processing speed was measured in 34 children at 4 years, 37 at 5 years, and 38 at 6 years and in 43 adults, with a battery of 8 computer-administered tests. Results showed clear age-related increases in processing speed that cannot be attributed to increased accuracy and error rate monitoring. Kail's model adequately accounted for the observed rate of developmental change in processing speed; however, the parameter estimates of R. Kail and Y. Park (1992) provided more accurate predictions than did the meta-analytically derived estimates of Kail (1991). Findings support the global developmental trend hypothesis and suggest that this trend extends beyond the range of verbal skills evaluated in previous research.

Adult↗
PubMed1997

Changes in vitamin B-6 status indicators of women fed a constant protein diet with varying levels of vitamin B-6.

Changes in vitamin B-6 status indicators were evaluated in vitamin B-6-replete subjects. Ten young women consumed diets providing 85 g protein/d and 1.03, 1.33, 1.73, and 2.39 mg vitamin B-6/d for 12 or 15 d during four successive diet periods; in a second study, six women were fed diets providing 85 g protein/d and 0.84, 1.14, and 2.34 mg vitamin B-6/d for 10 or 12 d during three successive diet periods. Vitamin B-6 status indicators showing significant differences among intakes included urinary excretion of 4-pyridoxic acid and total vitamin B-6, pyridoxal 5'-phosphate and total vitamin B-6 in plasma, and xanthurenic acid excretion after a 2-g L-tryptophan load. Significant correlations were found between vitamin B-6 intake and 4-pyridoxic acid, total vitamin B-6, plasma pyridoxal 5'-phosphate, plasma total vitamin B-6, erythrocyte alanine aminotransferase percentage stimulation and postload excretion of xanthurenic acid and volatile amines (kynurenine plus acetylkynurenine). Depending on the indicator, between 20% and 70% of the subjects had inadequate values for 4-pyridoxic acid, total vitamin B-6, plasma pyridoxal 5'-phosphate, and erythrocyte alanine aminotransferase percentage stimulation at a vitamin B-6 intake of 1.33 mg/d (0.016 mg vitamin B-6/g protein). A ratio of dietary vitamin B-6 to protein > 0.016 mg/g is required for adequate vitamin B-6 status in women.

Adult↗
PubMed1997

Experimental evaluation of "The Images Within": an alcohol education and prevention program.

A program titled "The Images Within" was implemented and evaluated in three sites on the east coast of the United States. This school curriculum uses art work developed by children of alcoholics to stimulate classroom discussions of the problems of parental alcohol abuse. The evaluation with 278 experimental and 310 control students indicated increased knowledge about the effects of alcohol and improved skills in coping with alcohol problems and help seeking behavior. Process data indicated that related programs were initiated, students were stimulated by the program and teachers were positive in their perceptions of the program. Schools implementing this program need to have developed referral networks to handle the individual concerns that are expressed as a result of participation in "The Images Within."

Adaptation, Psychological↗
PubMed1996

Vitamin B-6 status indicators decrease in women consuming a diet high in pyridoxine glucoside.

Previous research has shown that the pyridoxine glucoside (PNG) form of vitamin B-6 has a reduced bioavailability compared with pyridoxine, but its effect on vitamin B-6 status has not been assessed. Following an 8-d adjustment period, nine women consumed diets containing a high or low amount of PNG for 18 d each, in a crossover design. The high and low PNG diets provided 1.52 mg/d (8.98 micromol/d) and 1.44 mg/d (8.57 micromol/d) of vitamin B-6, of which 27% and 9% was PNG, respectively. The dietary vitamin B-6 to protein ratio of both diets was 0.017 mg/g. Urinary excretions of 4-pyridoxic acid and total vitamin B-6 were significantly lower (P < 0.05) during the high PNG diet period than when the low PNG diet was consumed. Urinary PNG excretion was equal to about 9% of the total PNG intake during both periods. Plasma total vitamin B-6 (P < 0.01) and red blood cell pyridoxal 5'-phosphate (PLP) (P < 0.05) were significantly lower when the high PNG diet was consumed than during the low PNG diet period. Fecal total vitamin B-6 excretion was significantly higher (P < 0.001) when the high PNG diet was consumed. Women consuming a diet containing a higher percentage of the total vitamin B-6 intake as PNG exhibited a decrease in vitamin B-6 status indicators, consistent with the reduced bioavailability of PNG demonstrated in other studies, equal to a loss of 15-18% of the total vitamin B-6 intake. During the determination of Recommended Dietary Allowances, the reduced bioavailability of PNG and its presence in higher amounts in some diets should be considered.

Adult↗
PubMed1996

Vitamin B-6 status of women with a constant intake of vitamin B-6 changes with three levels of dietary protein.

To determine the effect of varying levels of dietary protein with a constant intake of vitamin B-6 (B-6) on B-6 status, nine women were fed diets providing daily intakes of 1.25 mg B-6 and 0.5, 1.0 and 2.0 g protein/kg body weight. After an 8-d adjustment period, the women consumed each level of dietary protein for 14 d in a Latin-square design. Several direct and indirect B-6 status indicators were measured in blood and urine. Significant differences among protein levels were found for urinary 4-pyridoxic acid (4-PA) excretion (P < 0.01), plasma pyridoxal 5'-phosphate (PLP) concentration (P < 0.05), and urinary excretion of volatile amines (VA, kynurenine plus acetylkynurenine) after a 2-g L-tryptophan load (P < 0.05). Nitrogen intake was significantly negatively correlated with urinary 4-PA excretion (r = -0.619, P < 0.001) and plasma PLP concentration (r = -0.549, P < 0.01), and positively correlated with erythrocyte alanine aminotransferase percentage stimulation (r = 0.418, P < 0.05) and urinary post-tryptophan load excretion of xanthurenic acid (r = 0.535, P < 0.05), kynurenic acid (r = 0.563, P < 0.05) and VA (r = 0.626, P < 0.01). Compared with men consuming diets with similar B-6 to protein ratios In a previous study, the women excreted a greater percentage of the B-6 intake as 4-PA, had lower plasma PLP concentrations and excreted greater amounts of postload urinary tryptophan metabolites at all three protein levels. If the Recommended Dietary Allowance (RDA) of vitamin B-6 is to be based on the dietary B-6 to protein ratio, gender differences in response to varying protein intakes should be considered. For the levels of protein intake used in this study and a B-6 intake of 1.25 mg/d, a B-6 to protein ratio of greater than 0.020 mg/g is required for adequate vitamin B-6 status in women.

Adult↗
PubMed1992

Vaccine storage practices in pediatric offices.

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.

Bacterial Vaccines↗
PubMed1990

Validity of self-report of adaptive behavior skills by adults with mental retardation.

The validity of self-reports of 48 adults with mental retardation of daily living competency using the recently revised Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984) was investigated. Self-report was compared to standard Vineland interviews of subjects' program counselors and to demonstrated competency in a real-life setting. On domains measuring adaptive skills, the subject and counselor interviews yielded highly consistent results. On the optional Maladaptive Behavior domain, however, the subjects with mental retardation underreported problematic behavior. Response validity and implications for use of self-report for program planning and placement decisions were discussed.

Activities of Daily Living↗