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PubMed1995

Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older.

OBJECTIVE: To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over. DESIGN: Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group. SETTING: The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London. PARTICIPANTS: Fifty-two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre- and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years). INTERVENTIONS: Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1-1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls. MEASUREMENTS: Pre- and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118-m self-paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre- and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one-sided Fishers exact test (2 x 2 table) for discontinuous data. RESULTS: Improvements in IKES (mean change 27%, P = .03), IEFS (22%, P = .05), HGS (4%, P = .05), LEP/kg (18%, P = .05) were associated with training, but the improvement in LEP (18%, P = .11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%, P = .02) and a small improvement in step up height (median 5%, P = .005). The other functional tests did not improve. CONCLUSIONS: Progressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent, very old women.

Activities of Daily Living↗
PubMed2003

Daily pain and symptoms in children with polyarticular arthritis.

OBJECTIVE: To analyze patterns of daily pain, stiffness, and fatigue related to juvenile arthritis; to examine the relationships of demographics, disease severity, and psychological adjustment to daily disease symptoms; and to examine daily disease symptoms as predictors of reduced participation in school and social activity. METHODS: For a 2-month period, 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function. Children also underwent an initial evaluation and 4 followup evaluations that included a joint count, laboratory testing, and completion of questionnaires assessing physical and psychosocial functioning. RESULTS: Children reported having pain an average of 73% of days, with the majority of children (76%) reporting pain on >60% of all days. On average, children described the intensity of their daily pain as being in the mild to moderate range; however, a significant subgroup (31%) reported pain in the severe range. Higher physician global assessment ratings, increased functional disability, and increased anxiety were significantly associated with increased daily pain and other daily symptoms. Multilevel random-effects analyses indicated that increased daily symptoms of pain, stiffness, and fatigue were significant predictors of reduced participation in school and social activities. CONCLUSION: Physicians should consider treating pain more aggressively in children with arthritis, in order to preserve function in school and social domains, as well as physical function. Moreover, optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as standard pharmacologic interventions.

Activities of Daily Living↗
PubMed2002

Differences in postural control and movement performance during goal directed reaching in children with developmental coordination disorder.

Poor upper-limb coordination is a common difficulty for children with developmental coordination disorder (DCD). One hypothesis is that deviant muscle timing in proximal muscle groups results in poor postural and movement control. The relationship between muscle timing, arm motion and children's upper-limb coordination deficits has not previously been studied. The aim of this study was to investigate the relationship between functional difficulties with upper-limb motor skills and neuromuscular components of postural stability and coordination. Sixty-four children aged 8-10 years, 32 with DCD and 32 without DCD, participated in the study. The study investigated timing of muscle activity and resultant arm movement during a rapid, voluntary, goal-directed arm movement. Results showed that compared to children without DCD, children with DCD took significantly longer to respond to visual signals and longer to complete the goal-directed movement. Children with DCD also demonstrated altered activity in postural muscles. In particular, shoulder muscles, except for serratus anterior, and posterior trunk muscles demonstrated early activation. Further, anterior trunk muscles demonstrated delayed activation. In children with DCD, anticipatory function was not present in three of the four anterior trunk muscles. These differences support the hypothesis that in children with DCD, altered postural muscle activity may contribute to poor proximal stability and consequently poor arm movement control when performing goal-directed movement. These results have educational and functional implications for children at school and during activities of daily living and leisure activities and for clinicians assessing and treating children with DCD.

Child↗
PubMed1999

[Premature birth and cognitive functioning in adolescence].

Premature infants are considered a high-risk population for developing cognitive dysfunction. Studies have indicated lower cognitive performance among elementary school children born prematurely. We focused on cognitive functioning of such adolescents. This age was chosen because of its critical importance in the development of the individual. 50 adolescents aged 14-16 years born prematurely were compared with 50 born at full-term and matched for gender, age and socioeconomic status. All subjects attended regular schools and did not suffer severe neurological disorders. Cognitive functioning was measured by the Bender-Visual Motor Gestalt Test and by 3 subtests from the Wechsler Intelligence Scale for Children (revised WISC-R test). Results revealed that prematurely born adolescents scored lower than those born at term on all measures of cognitive performance. The results are discussed in terms of their developmental meaning and of therapy for the prematurely born.

Adolescent↗
PubMed1994

Developmental and service needs of school-age children with human immunodeficiency virus infection: a descriptive study.

OBJECTIVE: To describe the developmental functioning and service needs of a group of school-age children with human immunodeficiency virus (HIV) infection. DESIGN: Retrospective data were collected through chart reviews and follow-up telephone calls to primary care givers. SETTING: A multidisciplinary team provided care at a developmental diagnostic and treatment center. PATIENTS: Cases were 90 school-age children (ages 5 to 14 years) with presumed perinatally acquired HIV infection. RESULTS: Forty-four percent of the 86 children on whom there were diagnoses were functioning in the low average to average range of intelligence, whereas 56% were functioning in the borderline range or lower. Fifty percent of the children demonstrated significant language impairments, with 28% also demonstrating an articulation disorder. Thirty-six of the children (42%) were formally diagnosed as having emotional/behavioral disorders. Eighty-six of the children were in school-based programs and of that group, 74% were in special education classes and receiving related services. CONCLUSIONS: Most of the children in this study demonstrated deficits in the cognitive and learning areas, although they are clearly functioning better than earlier studies of children with HIV infection would have predicted. Their service needs include alternative living arrangements, remedial education, and psychotherapeutic interventions. The children's increasing longevity will place strains on the respective service systems.

Adolescent↗
PubMed2001

The effect of shoulder-girdle loading by a school bag on lung volumes in Chinese primary school children.

BACKGROUND: Heavy loading of the spine may induce musculoskeletal problems in children. Local surveys reported frequent overloading of school bags carried by primary school children. The effect of an overweight school bag on the child's lung function has not been reported. AIMS: To investigate the effect of shoulder-girdle loading on forced expiratory lung volumes in primary school children and to compare this effect with that of an assumed kyphotic posture. STUDY DESIGN AND SUBJECTS: Forty-three primary school children, mean age 9.6 years underwent spirometry lung-function measurements, while adopting the following five conditions in random order: free standing; kyphotic standing; standing wearing a backpack weighing 10%, 20% and 30% of their body weight. OUTCOMES MEASURES: Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEF). RESULTS: There were no significant differences in FEV1 and FVC between free standing and the 10% body weight load. However, both FEV1 and FVC decreased significantly when the student adopted the kyphotic posture and when the load in the backpack was increased to 20% and 30% of body weight. CONCLUSIONS: This study demonstrates a restrictive effect on lung volumes when a school-bag load is heavier than 10% of a child's body weight. Our results also confirm the detrimental effect of a kyphotic posture on pulmonary mechanics and the necessity for health-care professionals to advocate proper postural advice to school children, teachers and parents.

Child↗
PubMed2004

Urban adolescents' exposure to community violence: the role of support, school safety, and social constraints in a school-based sample of boys and girls.

This study examined recent exposure to violence in the community and in other settings, protective factors, and current psychological functioning among 349 young adolescents from 9 urban middle schools. The majority (76%) of adolescents reported witnessing or being victimized by at least 1 violent event in the prior 6 months. Nearly half of adolescents who had talked about their experience of a violent event reported feeling constrained from sharing their thoughts or feelings because of others' reactions. After controlling for daily hassles, more exposure to violence was associated with more self-reported posttraumatic stress disorder (PTSD) and depressive symptoms. Exposure to violence was not a significant predictor of teachers' ratings of adaptive functioning or internalizing symptoms. Support from specific individuals, perceived school safety, and lower constraints for discussing violence showed protective effects in the relation between exposure to violence and specific dimensions of psychological functioning. The implications of this research for school-based interventions are discussed.

Adolescent↗
PubMed1981

Implementing comprehensive health education: educational innovations and social change.

The effectiveness of health education is ultimately determined by whether it is implemented, and how it is implemented. Although a given health education innovation may be designed and experimentally assessed to promote well-being with some measure of effectiveness and efficiency, the actual impact of the innovation will depend upon the manner in which it is disseminated, initiated, and maintained. The implementation of health education programs in schools or elsewhere is a function of the types of innovations available, certain characteristics of those innovations that influence their use, and the manner in which the innovations are brought into practice. This paper has been prepared to review, synthesize, and apply current and relevant information about educational innovations and social change to provide a conceptual base for the design, execution, and analysis of efforts to implement health education in schools. The American system of public and private schools could be an agent vitally important to the realization of a second public health revolution. Indeed, in a democratic society, the implementation of health education in schools seems a condition necessary for such a revolution. By analyzing and learning from our own health education efforts, as well as the efforts of those experienced with implementing other types of educational innovations in schools, we might ensure that future populations are informed sufficiently about factors that influence their health and well-being.

Adolescent↗
PubMed2004

Developmental gains in early intervention based on conductive education by young children with motor disorders.

The purpose of the study was to evaluate the developmental gains of 26 young children with cerebral palsy and three children with other disorders attending early intervention based on the principles of conductive education (NZCE) or community-based (CB). Conductive education was implemented by parents supervised by a conductor an average of 7.4 hours per week. Developmental skills were objectively measured in functional contexts at home and school before the child entered the programme and after 12 months. Skill gains by children with spastic quadriplegia, cerebral palsy and severe developmental delay who were not able to sit independently (n = 6) who participated in NZCE were significantly greater (p < 0.001) than skill gains by children with similar disabilities who participated in CB (n = 6). Children with quadriplegic cerebral palsy, severe developmental delay, epilepsy and sensory disabilities (n = 7) also achieved significant gains in functional skills in NZCE (p < 0.005). Conductive education may benefit young children with motor dysfunction as well as concomitant disorders and severe developmental delay. Gains were not related to intensity, age, or a product of maturation, but may be related to changed patterns of maternal-child interactions.

Cerebral Palsy↗
PubMed1995

Adrenocortical and behavioral predictors of immune responses to starting school.

Associations between major psychologic stressors and immune function have been documented in previous research, but few studies have investigated immune changes attending minor, normative stressors. This study examined adrenocortical and behavioral predictors of immune responses to starting kindergarten in 39 five-year-old children, who completed laboratory visits for venipunctures 1 wk before (time 1) and 1 wk after (time 2) school entry. At time 1, children were also immunized with pneumococcal vaccine. Immune responses were measured as change scores for T (CD4+ and CD8+) cells, B (CD19+) cells, lymphoproliferative responses to pokeweed mitogen (PWM), and type-specific pneumococcal antibody responses (ABR). Adrenocortical response was assessed as the change in salivary cortisol level, and behavioral difficulty with school adjustment was scored using parental ratings of behavior problems, stress due to changes in routines, and degree of adaptive challenge. Salivary cortisol rose after kindergarten entry (means = 0.39 +/- 0.28 to 0.49 +/- 0.36 micrograms/dL, p = 0.03) and was unrelated to behavioral difficulties. CD4+ cells increased in number, whereas PWM declined, and CD19+ cells showed a borderline increase. Change in salivary cortisol was positively associated with change in CD19+ (delta CD19+) and inversely related to ABR. Scores for behavioral difficulty were inversely associated with delta CD4+ and delta CD19+. These data suggest that: 1) school entry is a stressor capable of evoking elevations in cortisol and behavior problems, accompanied by shifts in functional and enumerative measures of immune status; and 2) children with greater adrenocortical reactivity have increases in B cell numbers and less effective B cell-mediated antibody production, whereas children with more behavioral difficulties show declines in all T and B cell subsets.

Adrenal Cortex↗
PubMed1993

Visual functions in a Swedish population of dyslexic and normally reading children.

Eighty-six 9-year old dyslexic children were carefully matched to controls with regard to age, sex, class in school, and intelligence and thorough visual functions tests and eye examinations were performed. As a group the dyslexic pupils exhibited a lower distance as well as near visual acuity both with monocular and binocular viewing. Furthermore, the dyslexic pupils had a lower contrast sensitivity at the lower and higher spatial frequencies. These differences were all statistically significant. However, no statistically significant differences between the two groups could be observed regarding refractive errors or contrast sensitivity in the middle spatial frequency range. Although some eyes were amblyopic, any severe eye anomalies or diseases were not found in any of the investigated children.

Child↗
PubMed2002

Laboratory pain reactivity and gender: relationship to school nurse visits and school absences.

Currently, there are no clear methods for identifying children vulnerable to frequent school absences. Our study examined relationships between gender and laboratory pain reactivity to the cold-pressor task (CPT), and parent-involved school absences and self-initiated school nurse visits in 57 children (36 female; ages 8-10 years). Using multiple regression analyses, CPT pain ratings, tolerance, and gender were analyzed in relation to nurse visits and absences collected prospectively across 2 years. We found that higher pain ratings and female gender predicted more absences; female gender also predicted increased nurse visits for acute complaints with documented physical findings. Our results suggest that laboratory pain reactivity is a potentially useful indicator of vulnerability to parent-involved functional impairment, as indexed by school absences, and that girls are more likely than boys to miss school and visit the nurse for acute illnesses. Limitations and pathways for further study are discussed.

Absenteeism↗
PubMedDate not supplied

Social competence and behavioural problems in children with hearing impairment.

The focus in this study is on social competence and behavioural problems in a group (n=57) of hearing-impaired 7- to 12-year-old children. Results were related to hearing status, school placement, and gender. Parent and teacher questionnaires were used to measure two aspects of social competence, prosocial orientation and social initiative, and three aspects of behavioural problems, externalizing, internalizing, and concentration problems. A sample of 214 normally-hearing children was used as a comparison group. Overall, the results showed only minor differences between the two groups, with the exception that the hearing-impaired children showed less social initiative in parent ratings. There were no relationships between social functioning and hearing status or school placement (mainstream vs. special classes for hearing-impaired children) nor any clear pattern of gender differences. These findings indicate that hearing-impaired children in Sweden fare well. The results are discussed in terms of the need for longitudinal studies and possible interventions targeted at social behaviours.

Child↗
PubMed1988

Adolescent stress factors: implications for the nurse practitioner.

This article present results of a descriptive study designed to assess gender differences in stress factors of adolescents attending rural, urban and suburban public schools. The Roy Adaptation Model of Nursing was selected as the theoretical framework for the study. Subjects were 323 freshmen in high schools in eastern Tennessee; mean age was 15.5 years. Most frequently reported stressors were hassling with parents, hassling with siblings, and making new friends. There was little difference between boys and girls in prevalence of these stress factors. However, gender differences in amount and types of other stressors were identified. Regardless of geographic location, mean stress scores of females were higher; urban females reported the highest stress levels. Females were more concerned with self-concept issues and interdependence issues, whereas males were more concerned with role function issues. Nurse practitioners and school nurses have unique opportunities to promote improved adaptation in adolescents experiencing stress. Intervention strategies are proposed for each of the four adaptation modes delineated by Roy.

Adaptation, Psychological↗
PubMed1996

[Rehabilitation of children and adolescents after organ transplantation].

Today transplantation of different vital organs is an often and successfully applied clinical method. After organ transplantation the degree of recovery mainly depends on graft function. Besides social, work and school reintegration as well as the development of independence and self-responsibility are decisive for a general recovery. Therefore a rehabilitation should be planned in the scope of the medical care after transplantation. For this reason the rehabilitation center for children and juvenile was founded in Stronach, Austria in 1992. Since then until March 1995 136 kidney- and 54 liver transplanted patients have been treated. There is a significant increase of hemoglobine in all cases and a significant decrease of creatinine as a parameter of graft function in kidney-transplanted patients. By spiroergometric testing the heartrate at the aerobic-anaerobic threshold can be easily estimated in children and juvenile and in consideration of these results the physical endurance can be distinctively increased by an individual training program.

Adolescent↗
PubMed2005

Outcome of a first episode of psychosis in adolescence: a 2-year follow-up.

Symptomatic and functional outcome and cognitive functioning were examined in adolescents experiencing their first episode of psychosis. The adolescents (n=69) were assessed and compared with adults (n=69), all presenting for treatment for the first time to a specialized Early Psychosis Program. Assessments were conducted at the initial presentation, and at 1- and 2-year follow-ups. Assessments included positive and negative symptoms, depression, number of relapses, substance use, cognitive functioning, age-appropriate productivity (employment or being in school) and quality of life. Adolescents showed both symptomatic and functional improvement over 2 years of optimal treatment. Positive and negative symptoms predicted outcome at 2 years. Compared with adults, the adolescents had similar clinical and functional outcomes but used more cannabis and had an increased number of relapses. These adolescents are doing relatively well following their first episode and reinforce the need to address cannabis use as an integral part of a comprehensive treatment program.

Adolescent↗
PubMed2006

Executive functions and seizure-related factors in children with epilepsy in Western Norway.

Executive functions (EFs), seizure-related factors, and school performance were studied in a population-based sample of children with epilepsy (n=117; 71 males, 46 females; mean age 10y 5mo [SD 2y]; range 6y-12y 11mo) and a comparison group (n=124; 71 males, 53 females; mean age 10y 1mo [SD 2y 1mo]; range 6y-12y 11mo). EF, cognitive function, depression, socioeconomic status, and school performance were examined. Patients with epilepsy performed significantly lower than the comparison group on all EF measures except incidental memory. Intellectual dysfunction and depression accounted for 43% of EF problems. All epilepsy syndrome groups (except Rolandic epilepsy) were associated with decreased EF in addition to early epilepsy onset, high seizure frequency, and polytherapy. Patients had more school performance problems than comparison children which were attributed partly to EF difficulties. All aspects of EF were affected in children with epilepsy and all epilepsy syndrome groups, except Rolandic epilepsy, influenced EF negatively. EF problems contributed to patients' school difficulties beyond intellectual dysfunction.

Catchment Area, Health↗
PubMedDate not supplied

Cognitive rehabilitation therapy of brain-injured students in a public high school setting.

Cognitive rehabilitation therapy is a systematic effort to assist brain damaged individuals in developing ways to compensate for cognitive deficits. Although this treatment is considered standard in a field of rehabilitation, access to services is limited by the availability of specialists. A model for bringing cognitive rehabilitation techniques to children with acquired brain injury within their own school setting is presented. A convenience sample of 10 public high school students with acquired brain injury received biweekly cognitive rehabilitation sessions for 20 weeks. Treatment was based on a developmental model of brain functioning. Treatments were provided by trained school teachers under the supervision of psychologists specializing in cognitive rehabilitation. Students were evaluated pre- and post-treatment using neuropsychological tests. After treatment, the students demonstrated a significant increase in general memory ability (p < 0.05). These gains were due mostly to increases in verbal learning ability. Integration of cognitive rehabilitation therapy with public school services is a significant step in providing this valuable treatment to a wider range of children with acquired brain injury.

Adolescent↗