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Physical Therapy Feb 2021Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
Our objective was to evaluate the efficacy of the Sitting Together and Reaching to Play (START-Play) intervention in young infants with neuromotor disorders.
METHOD
This randomized controlled trial compared usual care early intervention (UC-EI) with START-Play plus UC-EI. Analyses included 112 infants with motor delay (55 UC-EI, 57 START-Play) recruited at 7 to 16 months of age across 5 sites. START-Play included twice-weekly home visits with the infant and caregiver for 12 weeks provided by physical therapists trained in the START-Play intervention; UC-EI was not disrupted. Outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley); the Gross Motor Function Measure; reaching frequency; and the Assessment of Problem Solving in Play (APSP). Comparisons for the full group as well as separate comparisons for infants with mild motor delay and infants with significant motor delay were conducted. Piecewise linear mixed modeling estimated short- and long-term effects.
RESULTS
For infants with significant motor delay, positive effects of START-Play were observed at 3 months for Bayley cognition, Bayley fine motor, and APSP and at 12 months for Bayley fine motor and reaching frequency outcomes. For infants with mild motor delay, positive effects of START-Play for the Bayley receptive communication outcome were found. For the UC-EI group, the only difference between groups was a positive effect for the APSP outcome, observed at 3 months.
CONCLUSION
START-Play may advance reaching, problem solving, cognitive, and fine motor skills for young infants with significant motor delay over UC-EI in the short term. START-Play in addition to UC-EI may not improve motor/cognitive outcomes for infants with milder motor delays over and above usual care.
IMPACT
Concepts of embodied cognition, applied to early intervention in the START-Play intervention, may serve to advance cognition and motor skills in young infants with significant motor delays over usual care early intervention.
LAY SUMMARY
If you have a young infant with significant delays in motor skills, your physical therapist can work with you to develop play opportunities to enhance your child's problem solving, such as that used in the START-Play intervention, in addition to usual care to help your child advance cognitive and motor skills.
Topics: Child Development; Cognitive Dysfunction; Disability Evaluation; Exercise Therapy; Female; Humans; Infant; Male; Motor Skills Disorders; Nervous System Diseases; Problem Solving; Surveys and Questionnaires
PubMed: 33382406
DOI: 10.1093/ptj/pzaa232 -
Sports Health Jul 2016Shoulder dislocations are common in contact sports, yet guidelines regarding the best treatment strategy and time to return to play have not been clearly defined. (Review)
Review
CONTEXT
Shoulder dislocations are common in contact sports, yet guidelines regarding the best treatment strategy and time to return to play have not been clearly defined.
EVIDENCE ACQUISITION
Electronic databases, including PubMed, MEDLINE, and Embase, were reviewed for the years 1980 through 2015.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Much has been published about return to play after anterior shoulder dislocation, but almost all is derived from expert opinion and clinical experience rather than from well-designed studies. Recommendations vary and differ depending on age, sex, type of sport, position of the athlete, time in the sport's season, and associated pathology. Despite a lack of consensus and specific recommendations, there is agreement that before being allowed to return to sport, athletes should be pain free and demonstrate symmetric shoulder and bilateral scapular strength, with functional range of motion that allows sport-specific participation. Return to play usually occurs 2 to 3 weeks from the time of injury. Athletes with in-season shoulder instability returning to sport have demonstrated recurrence rates ranging from 37% to 90%. Increased bone loss, recurrent instability, and injury occurring near the end of season are all indications that may push surgeons and athletes toward earlier surgical intervention.
CONCLUSION
Most athletes are able to return to play within 2 to 3 weeks but there is a high risk of recurrent instability.
Topics: Algorithms; Athletic Injuries; Humans; Range of Motion, Articular; Recurrence; Return to Sport; Risk Factors; Shoulder Dislocation
PubMed: 27255423
DOI: 10.1177/1941738116651956 -
Physical Therapy Aug 2020The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol.
OBJECTIVE
The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy.
METHODS
This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group.
SETTINGS ARE URBAN
Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance.
IMPACT
More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.
Topics: Cerebral Palsy; Child Development; Child, Preschool; Developmental Disabilities; Early Medical Intervention; Exercise Therapy; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Longitudinal Studies; Motor Disorders; Motor Skills; Play Therapy; Problem Solving; Time Factors
PubMed: 32329778
DOI: 10.1093/ptj/pzaa077 -
The Cochrane Database of Systematic... Nov 2018Autism spectrum disorder (ASD) has an estimated prevalence of around 1.7% of the population. People with ASD often also have language difficulties, and about 25% to 30%... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Autism spectrum disorder (ASD) has an estimated prevalence of around 1.7% of the population. People with ASD often also have language difficulties, and about 25% to 30% of children with ASD either fail to develop functional language or are minimally verbal. The ability to communicate effectively is an essential life skill, and difficulties with communication can have a range of adverse outcomes, including poorer academic achievement, behavioural difficulties and reduced quality of life. Historically, most studies have investigated communication interventions for ASD in verbal children. We cannot assume the same interventions will work for minimally verbal children with ASD.
OBJECTIVES
To assess the effects of communication interventions for ASD in minimally verbal children.
SEARCH METHODS
We searched CENTRAL, MEDLINE and Embase as well as 12 other databases and three trials registers in November 2017. We also checked the reference lists of all included studies and relevant reviews, contacting experts in the field as well as authors of identified studies about other potentially relevant ongoing and unpublished studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of communication-focused interventions for children (under 12 years of age) diagnosed with ASD and who are minimally verbal (fewer than 30 functional words or unable to use speech alone to communicate), compared with no treatment, wait-list control or treatment as usual.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodological procedures.
MAIN RESULTS
This review includes two RCTs (154 children aged 32 months to 11 years) of communication interventions for ASD in minimally verbal children compared with a control group (treatment as usual). One RCT used a verbally based intervention (focused playtime intervention; FPI) administered by parents in the home, whereas the other used an alternative and augmentative communication (AAC) intervention (Picture Exchange Communication System; PECS) administered by teachers in a school setting.The FPI study took place in the USA and included 70 participants (64 boys) aged 32 to 82 months who were minimally verbal and had received a diagnosis of ASD. This intervention focused on developing coordinated toy play between child and parent. Participants received 12 in-home parent training sessions for 90 minutes per session for 12 weeks, and they were also invited to attend parent advocacy coaching sessions. This study was funded by the National Institute of Child Health and Human Development, the MIND Institute Research Program and a Professional Staff Congress-City University of New York grant. The PECS study included 84 minimally verbal participants (73 boys) aged 4 to 11 years who had a formal diagnosis of ASD and who were not using PECS beyond phase 1 at baseline. All children attended autism-specific classes or units, and most classes had a child to adult ratio of 2:1. Teachers and parents received PECS training (two-day workshop). PECS consultants also conducted six half-day consultations with each class once per month over five months. This study took place in the UK and was funded by the Three Guineas Trust.Both included studies had high or unclear risk of bias in at least four of the seven 'Risk of bias' categories, with a lack of blinding for participants and personnel being the most problematic area. Using the GRADE approach, we rated the overall quality of the evidence as very low due to risk of bias, imprecision (small sample sizes and wide confidence intervals) and because there was only one trial identified per type of intervention (i.e. verbally based or AAC).Both studies focused primarily on communication outcomes (verbal and non-verbal). One of the studies also collected information on social communication. The FPI study found no significant improvement in spoken communication, measured using the expressive language domain of the Mullen Scale of Early Learning expressive language, at postintervention. However, this study found that children with lower expressive language at baseline (less than 11.3 months age-equivalent) improved more than children with better expressive language and that the intervention produced expressive language gains in some children. The PECS study found that children enrolled in the AAC intervention were significantly more likely to use verbal initiations and PECS symbols immediately postintervention; however, gains were not maintained 10 months later. There was no evidence that AAC improved frequency of speech, verbal expressive vocabulary or children's social communication or pragmatic language immediately postintervention. Overall, neither of the interventions (PECS or FPI) resulted in maintained improvements in spoken or non-verbal communication in most children.Neither study collected information on adverse events, other communication skills, quality of life or behavioural outcomes.
AUTHORS' CONCLUSIONS
There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD. A substantial number of studies have investigated communication interventions for minimally verbal children with ASD, yet only two studies met inclusion criteria for this review, and we considered the overall quality of the evidence to be very low. In the study that used an AAC intervention, there were significant gains in frequency of PECS use and verbal and non-verbal initiations, but not in expressive vocabulary or social communication immediately postintervention. In the study that investigated a verbally based intervention, there were no significant gains in expressive language postintervention, but children with lower expressive language at the beginning of the study improved more than those with better expressive language at baseline. Neither study investigated adverse events, other communication skills, quality of life or behavioural outcomes. Future RCTs that compare two interventions and include a control group will allow us to better understand treatment effects in the context of spontaneous maturation and will allow further comparison of different interventions as well as the investigation of moderating factors.
Topics: Autism Spectrum Disorder; Child; Child, Preschool; Female; Humans; Language Development Disorders; Language Tests; Language Therapy; Male; Nonverbal Communication; Parents; Play Therapy; Randomized Controlled Trials as Topic; School Teachers; Teacher Training; Treatment Outcome
PubMed: 30395694
DOI: 10.1002/14651858.CD012324.pub2 -
Journal of Athletic Training Mar 2018To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries.
National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries.
OBJECTIVE
To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries.
BACKGROUND
In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries.
RECOMMENDATIONS
Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.
Topics: Arthroscopy; Athletes; Athletic Injuries; Humans; Male; Manipulation, Orthopedic; Orthopedic Procedures; Outcome and Process Assessment, Health Care; Pain Management; Physical Therapy Modalities; Practice Guidelines as Topic; Recovery of Function; Return to Sport; Shoulder Injuries
PubMed: 29624450
DOI: 10.4085/1062-6050-59-16 -
Innovations in Clinical Neuroscience May 2019Play therapy is a valuable tool in psychotherapy with children that has been shown to be effective in the treatment of mental illness and behavioral problems. In play... (Review)
Review
Play therapy is a valuable tool in psychotherapy with children that has been shown to be effective in the treatment of mental illness and behavioral problems. In play therapy, the therapist follows the child's lead through play, and the child expresses thoughts and feelings that might be difficult to communicate otherwise. The therapist creates a space to allow children to practice play and pretend, thus allowing the therapeutic alliance to develop. The eight tenets of play therapy are discussed, and an illustrative case vignette that demonstrates the common ego defenses and developmental hurdles that can be addressed in play therapy is presented.
PubMed: 31440400
DOI: No ID Found -
Irish Journal of Medical Science Dec 2022Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The... (Review)
Review
Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The incidence rate of newly diagnosed T1D in children continues to increase in Ireland Roche et al. (Eur J Pediatr 175(12):1913-1919, 2016) and worldwide Patterson et al. (Diabetologia 62(3):408-417, 2019). The objective of this study was to conduct a literature review of the effects of various non-pharmacological therapeutic modalities on the control of diabetes in children. A literature review was performed using PubMed, Medline, Embase and Cochrane library to evaluate play, art, music and exercise therapy in the treatment of DM using the keywords: "paediatric", "diabetes", "play therapy", "art therapy", "music therapy" and "exercise therapy". These search terms initially returned 270 cases, which resulted in a total of 11 papers being reviewed after eliminating duplicate or irrelevant papers. Literature review showed that all therapies have a positive impact on the child, but there is limited research looking at the impact of therapy on quantitative measures such as HbA1c or 'time in range'.
Topics: Child; Humans; Diabetes Mellitus, Type 1; Music; Insulin; Exercise Therapy; Music Therapy
PubMed: 35037160
DOI: 10.1007/s11845-021-02889-5 -
Drug Design, Development and Therapy 2021The mortality of hepatocellular carcinoma (HCC) is distributed unevenly worldwide. One of the major causes is hepatitis B or hepatitis C virus infection and the... (Review)
Review
The mortality of hepatocellular carcinoma (HCC) is distributed unevenly worldwide. One of the major causes is hepatitis B or hepatitis C virus infection and the development and progression of liver cirrhosis. The carcinogenesis of HCC is among others regulated via the mTOR (mechanistic target of rapamycin) signaling pathway and represents a possible method of targeted treatment. The aim of our article was to address the most recent clinical advances and findings of basic studies on the mTOR signaling pathway and the involved factors. Risk factors play a key role in dysregulation of the signaling pathway, where both mTORCs are upregulated and protein synthesis is altered. eIFs and, to a lesser extent, eEFs play an essential role in this process. Whether the factor will be upregulated or downregulated, among others, depends on hepatitis B/C virus infection. The amount of a particular factor in a patient sample lets us know whether HCC recurrence will occur, what is the likelihood of chemoresistance, and what outcome is predicted for patients with an increased value. Our analysis shows that in addition to mTOR, eIF3, eIF4, and eIF5 play an important role, as they can serve as biomarkers for non- and virus-related HCC.
Topics: Carcinoma, Hepatocellular; Disease Progression; Drug Resistance, Neoplasm; Gene Expression Regulation, Neoplastic; Hepatitis B; Hepatitis C; Humans; Liver Cirrhosis; Liver Neoplasms; Molecular Targeted Therapy; Risk Factors; Signal Transduction
PubMed: 34703211
DOI: 10.2147/DDDT.S255582 -
Pharmacology & Therapeutics Dec 2021Glioma is one of the most common and lethal brain tumors. Surgical resection followed by radiotherapy plus chemotherapy is the current standard of care for patients with... (Review)
Review
Glioma is one of the most common and lethal brain tumors. Surgical resection followed by radiotherapy plus chemotherapy is the current standard of care for patients with glioma. The existence of resistance to genotoxic therapy, as well as the nature of tumor heterogeneity greatly limits the efficacy of glioma therapy. DNA damage repair pathways play essential roles in many aspects of glioma biology such as cancer progression, therapy resistance, and tumor relapse. O6-methylguanine-DNA methyltransferase (MGMT) repairs the cytotoxic DNA lesion generated by temozolomide (TMZ), considered as the main mechanism of drug resistance. In addition, mismatch repair, base excision repair, and homologous recombination DNA repair also play pivotal roles in treatment resistance as well. Furthermore, cellular mechanisms, such as cancer stem cells, evasion from apoptosis, and metabolic reprogramming, also contribute to TMZ resistance in gliomas. Investigations over the past two decades have revealed comprehensive mechanisms of glioma therapy resistance, which has led to the development of novel therapeutic strategies and targeting molecules.
Topics: Brain Neoplasms; DNA Damage; Glioma; Humans
PubMed: 34171339
DOI: 10.1016/j.pharmthera.2021.107922 -
Mental Health (London) Oct 1941
PubMed: 28908993
DOI: No ID Found