Interictal epileptiform discharge (IED) is rarely observed in healthy volunteers without a history of seizures, but higher rates of occurrence are reported in children than in adults. Higher rates are also observed among neurologic inpatients and outpatients without a seizure history, but the risk of subsequent unprovoked seizures or epilepsy is low in healthy volunteers and patients. An exception is the patients with autism spectrum disorders, attention deficit/hyperactivity disorder, or cerebral palsy, who are predisposed to epilepsy development. However, it is currently unclear whether epilepsy risk is higher for patients with incidentally detected IED than for the patients without IED. Hospitalized patients with IED but no prior seizures often have underlying acute or progressive brain disorders. Although they have increased risk of acute seizures, the risk for subsequent unprovoked seizures or epilepsy is unknown and requires assessment on an individual basis. For patients who have psychogenic spells but no seizure history, the rate of IED detection is low, similar to that of healthy volunteers. The association between IED and transitory cognitive impairment has not been established in nonepileptic persons. Evidence thus far does not suggest that routine EEG screening of pilot candidates reduces risk of flight-related accidents.

Many individuals with neurological problems or anatomical abnormalities of the jaw, lips or oral cavity may drool, which can impact on health and quality of life. A thorough evaluation of the patient’s history, examination of the oral region by a speech pathologist and, in individuals over 3 years, a dental examination is warranted. Questionnaires with established validity such as the Drooling Impact Scale are useful assessment tools. A hierarchical approach to treatment is taken from least invasive therapies, such as speech pathology, to more invasive, such as injection of botulinum neurotoxin type-A (BoNT-A) into the salivary glands (parotid and submandibular). The wishes of the individual and their carer are crucial considerations in determining the suitability of the intervention for the patient. In the presence of dysphagia and cerebral palsy (CP), careful assessment is required prior to the injection of BoNT-A. Favourable responses to intervention include a reduction in the secretion of saliva and in drooling, as well as psychosocial improvements. BoNT-A is usually well tolerated, although potential side effects should be discussed with the patient and carer.

Dystonia in the neck region can be safely and effectively reduced with injections of Botulinum neurotoxin-A and B. People with idiopathic cervical dystonia have been studied the most. Benefits following injection include increased range of movement at the neck for head turning, decreased pain, and increased functional capacity (Class I evidence, level A recommendation). The evidence for efficacy and safety in patients with secondary dystonia in the neck is unclear based on the lack of rigorous research conducted in this heterogeneous population (level U recommendation). Psychometrically sound assessments and outcome measures exist to guide decision-making (Class I evidence, level A recommendation). Much less is known about the effectiveness of therapy to augment the effects of the injection (Class IV, level U recommendation). More research is needed to answer questions about safety and efficacy in secondary spastic neck dystonia, effective adjunctive therapy, dosing and favourable injection techniques.

Botulinum neurotoxin type-A (BoNT-A) has been used in association with other interventions in the management of spasticity in children with cerebral palsy (CP) for almost two decades. This consensus statement is based on an extensive review of the literature by an invited international committee. The use of BoNT-A in the lower limbs of children with spasticity caused by CP is reported using the American Academy of Neurology Classification of Evidence for therapeutic intervention. Randomized clinical trials have been grouped into five areas of management, and the outcomes are presented as treatment recommendations. The assessment of children with CP and evaluation of outcomes following injection of BoNT-A are complex, and therefore, a range of measures and the involvement of a multidisciplinary team is recommended. The committee concludes that injection of BoNT-A in children with CP is generally safe although systemic adverse events may occur, especially in children with more physical limitations (GMFCS V). The recommended dose levels are intermediate between previous consensus statements. The committee further concludes that injection of BoNT-A is effective in the management of lower limb spasticity in children with CP, and when combined with physiotherapy and the use of orthoses, these interventions may improve gait and goal attainment.

OBJECTIVE: To identify risk factors for self-injurious behavior in young children with developmental delay and to determine whether that group is also more likely to exhibit other challenging behaviors. STUDY DESIGN: A retrospective chart review of 196 children <6 years of age referred for comprehensive neurodevelopmental evaluations. We analyzed child developmental level, receptive and expressive communication level, mobility, visual and auditory impairment, and co-morbid diagnoses of cerebral palsy, seizure disorders, and autism. RESULTS: Sixty-three children (32%; mean age = 42.7 mo, 63% male) were reported to engage in self-injurious behavior at the time of the evaluation. Children with and without self-injurious behavior did not differ on overall developmental level, expressive or receptive language level, mobility status or sensory functioning, or in rates of identification with cerebral palsy, seizure disorders, or autism. However, the self-injurious behavior group was rated significantly higher by parents on destructive behavior, hurting others, and unusual habits. CONCLUSIONS: Although self-injurious behavior was reported to occur in 32% of the cohort, the modal frequency was monthly/weekly and the severity was low. No significant differences were found for risk markers reported for adults, adolescents, and older children with intellectual and developmental disabilities. However, self-injurious behavior was comorbid with other behavior problems in this sample. Copyright © 2010 Mosby, Inc. All rights reserved.

Purpose: The purpose of this study was to examine the inter-rater reliability of two tests measuring selective motor control (SMC) of the lower extremities in children with cerebral palsy (CP). Methods: Two testers independently assessed 21 children (13 boys, eight girls; mean age 6 years 5 months, SD 12 months) with spastic CP (14 unilateral and seven bilateral) using the Boyd and Graham SMC test (with an existing protocol) and the modified Trost SMC test (with a newly developed protocol). Inter-rater reliability was analysed using Cohen’s Kappa. Results: For the Boyd and Graham SMC test for ankle dorsiflexion, Kappa was 0.55 (95% CI = 0.36-0.74). For the modified Trost SMC test for ankle dorsiflexion, knee extension, hip abduction and hip flexion, Kappas were 0.65 (0.47-0.84), 0.69 (0.49-0.88), 0.57 (0.37-0.78) and 0.71 (0.51-0.91), respectively. Conclusion: The SMC tests showed moderate (Boyd and Graham SMC test) to good (modified Trost SMC test) inter-rater reliability.

Cerebral palsy (CP) is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, however determining which abnormalities are primary, and which are secondary, is a difficult task. Deformity of the foot has anecdotally been reported to produce compensatory abnormalities in more proximal lower limb joints, as well as in the contralateral limb. However, the exact nature of these compensations is unclear. The aim of this paper was to provide clear and objective criteria for identifying compensatory mechanisms in children with spastic hemiplegic CP, in order to improve the prediction of the outcome of foot surgery, and to enhance treatment planning. Twelve children with CP were assessed using conventional gait analysis along with the Oxford Foot Model prior to and following surgery to correct foot deformity. Only those variables not directly influenced by foot surgery were assessed. Any that spontaneously corrected following foot surgery were identified as compensations. Pelvic rotation, internal rotation of the affected hip and external rotation of the non-affected hip tended to spontaneously correct. Increased hip flexion on the affected side, along with reduced hip extension on the non-affected side also appeared to be compensations. It is likely that forefoot supination occurs secondary to deviations of the hindfoot in the coronal plane. Abnormal activity in the tibialis anterior muscle may be consequent to tightness and overactivity of the plantarflexors. On the non-affected side, increased plantarflexion during stance also resolved following surgery to the affected side. Copyright © 2010 Elsevier B.V. All rights reserved.

Associating musculoskeletal models to motion analysis data enables the determination of the muscular lengths, lengthening rates and moment arms of the muscles during the studied movement. Therefore, those models must be anatomically personalized and able to identify realistic muscular paths. Different kinds of algorithms exist to achieve this last issue, such as the wired models and the finite elements ones. After having studied the advantages and drawbacks of each one, we present the convex wrapping algorithm. Its purpose is to identify the shortest path from the origin to the insertion of a muscle wrapping over the underlying skeleton mesh while respecting possible non-sliding constraints. After the presentation of the algorithm, the results obtained are compared to a classically used wrapping surface algorithm (obstacle set method) by measuring the length and moment arm of the semitendinosus muscle during an asymptomatic gait. The convex wrapping algorithm gives an efficient and realistic way of identifying the muscular paths with respect to the underlying bones mesh without the need to define simplified geometric forms. It also enables the identification of the centroid path of the muscles if their thickness evolution function is known. All this presents a particular interest when studying populations presenting noticeable bone deformations, such as those observed in cerebral palsy or rheumatic pathologies. Copyright © 2010 Elsevier Ltd. All rights reserved.

Empathy is an important attribute for occupational therapists in establishing rapport and in better understanding their clients. However, empathy can be compromised by high workloads, personal stressors and pressures to demonstrate efficacy. Occupational therapists also work with patients from a variety of diagnostic groups. The objective of this study was to determine the extent of empathy and attitudes towards clients amongst undergraduate occupational therapy students at one Australian University. A cross-sectional study was undertaken using a written survey of the Jefferson Scale of Physician Empathy (JSPE) and the Medical Condition Regard Scale. Overall, a strong level of empathy was reported amongst students. Four medical conditions that occupational therapists work with (stroke, cerebral palsy, traumatic brain injury and depression) were held in high regard. Substance abuse, however, was held in comparatively low regard. Overall, the year of study appeared to have no significant impact on the students' empathy. Despite having a lower reported empathy level than found in health professions from other studies using the JSPE, occupational therapy students were found to have a good level of empathy. Of concern, however, was the bias reported against the medical condition of substance abuse, highlighting that the there may be a need to reinforce that patients from this diagnostic group are equally deserving of quality care irrespective of their clinical condition. Recommendations for future research include completing a longitudinal study of occupational therapy students' empathy levels and investigating the empathy levels of occupational therapists working with different client groups. Limitations of the study include the convenience sampling of occupational therapy students enrolled at one university which limits the generalizability of the results to groups of participants with similar characteristics. Copyright (c) 2010 John Wiley & Sons, Ltd.

A 12-year-old boy with hemiparesis, severe mental retardation, reduced mobility and behavioural problems was not yet toilet trained. He was successfully trained using a behavioural treatment. The training program was based on gradual prolongation of urine retention, the introduction of behaviour restrictions, rewards for using the toilet and overcorrection using repeated exercises if diurnal enuresis occurred. A third of 4- to 18-year-olds with a cerebral palsy do not have diurnal bladder control at the age of 6, in contrast to 1-3% in the general population. An important cause of this difference is the believe that bladder control is dependent on the time of development of bladder control muscles and that it cannot be affected by external methods. This case study shows that even in a relatively older and severely and multiply disabled boy diurnal enuresis can be solved.